Platelet rich plasma | anjus-clinic

Platelet-rich plasma intra-uterine infusion

The health of the uterine lining (endometrium) has an important role in implantation and clinical pregnancy success. Platelet-rich-plasma (PRP) IUI procedure is a new treatment option for patients undergoing assisted reproduction. Through a complex series of cellular events, the platelet-released bio-active growth factors initiate intensive endometrial regeneration leading to improved endometrial thickness.

Published research has demonstrated that PRP may improve implantation rate and clinical pregnancy rate for the following clinical presentations:

Patients with a thin endometrium
Patients with an endometrium that hasn’t responded sufficiently to medical therapies
Patients who have repeated implantation failures

What is PRP?

PRP is an extract of your own blood that contains a high concentration of platelets, growth factors, and bio-active proteins essential for tissue regeneration and healing. Doctors have used PRP for many years to accelerate surgical healing; repair tendon, ligament and joint damage; heal skin wounds; and help regrow muscle and bone. The same physiological process that aids tissue regeneration and healing in other areas of the body occurs when PRP is used to improve endometrial thickness.

Why use PRP to improve the endometrium?

When PRP is infused within the uterine cavity, platelets release their growth factors, which exert a local regenerative effect on the endometrial tissue. These growth factors stimulate cellular processes within the endometrium that lead to increased blood flow and cellular growth-resulting in improved endometrial thickness.

Benefits of PRP IUI

For some patients, PRP IUI will improve endometrial thickness leading to a reduction in frozen embryo transfer cancellation, with a subsequent decrease in psychological and financial stress for patients. Published research has shown that PRP initiated endometrial improvement provides an increase in pregnancy rate and live birth rate. As this is relatively new research and studies are small, further research is required to further validate these findings.

How is the PRP is extracted from patient’s blood?

The patient's blood is collected in the same way as a standard blood test. Using a platelet-concentrating device and a centrifuge, the platelets are separated from the whole blood and are collected in 1ml of plasma. This small volume of plasma with a high platelet concentration is the PRP. Using this TGA approved technology it is possible to extract a very ‘pure’ PRP sample with over 90% platelet collection efficiency, so that maximum growth factors can be introduced to the uterine cavity.

How is the infusion performed?

The procedure is performed at Specialists on Honeysuckle during a 30-45 minute appointment. It will be similar to a cervical screening test or embryo transfer in terms of positioning and discomfort.

After the PRP has been collected, the patient will be positioned on the treatment bed and a speculum will be used so that a fine tube can be placed through the cervix into the uterine cavity. The insertion of the tube through the cervix may be uncomfortable–please keep our staff informed of how you are feeling. Once the tube is in position, the PRP syringe will be attached and the 1-1.25mls of PRP will be infused. The infusion tube and speculum will then be removed and we will ask you to remain on the treatment bed for 10 minutes as 90% of the platelet-contained growth factors are released within the first 10 minutes.

When is the procedure performed?

Your fertility specialist will advise the best day of cycle to have the PRP IUI procedure performed. The endometrial thickness will be checked by ultrasound 48-72 hours after PRP procedure. If the endometrium has not adequately thickened by that time, a repeat PRP procedure may be performed.

Are there any side effects?

As the product that is being injected is a portion of the patient’s blood, PRP is considered to be low risk, with very minimal chance of an allergic reaction or adverse outcome. However, like all medical procedures where a tube is inserted through the cervix, there is always a small risk of infection. Some people may also become dizzy or light-headed during the proceudre.

Pre-procedure instructions

Please inform our staff prior to the day of the PRP procedure if you have any of the following, as we may not be able to perform your PRP procedure:

Platelet disorders and blood disorders

Acute or chronic infections (eg: urinary tract infection)

Severe systemic or metabolic conditions/ disorders if any of the above applies to you currently, please discuss with our staff.

To maximise the potential healing effect from the PRP we recommend the following guidelines

**Please seek advice from your Fertility Specialist prior to ceasing any prescribed medication for your PRP procedure

2 Days prior to the procedure:

Discontinue any non-steroidal anti-inflammatory medications such as Nurofen, ibuprofen, Voltaren, Celebrex, Mobic, or any other prescribed anti-inflammatory medications. Cease from 2 days prior until 10 days after the PRP therapy.
Minimise caffeine, alcohol and fatty food and ideally have a healthy diet
Drink at least one litre of water each day for good hydration (at least 2 litres in hot weather)

Day of procedure:

Shower prior to procedure.
Drink at least one litre of water and refrain from excessive exercise (to assist blood collection)
Please eat within 4 hours of the blood collection. Ideally have a low-fat meal / snacks to assist with visibility of the concentrated platelets during PRP collection.

Post-procedure instructions

The PRP that is extracted from your blood and infused within your uterine cavity is fragile, and needs to be treated carefully, especially in the first 24 hours so that it can complete ‘its regenerative work’. Please take the time to read this information so that you can gain maximum benefit from the PRP IUI procedure.

What to expect post intra-uterine infusion

When the PRP is introduced to the uterine cavity, the platelets release bioactive proteins and growth factors, which act on cells in that location. The highly concentrated growth factors immediately stimulate your body’s normal healing responses-attract stem cells to the area, initiate new blood vessel formation, increase blood supply and necessary proteins to regenerate the tissue.

Hundreds of different biochemical processes occur within minutes after infusion so patients should feel some type of ‘activity’ related to the increased metabolic processes and blood flow after injection. The degree to which this is felt is variable. Some patients describe it as a feeling of fullness, tightness, warmth, dull throbbing or fluttering. Symptoms will ease over the first 24 hours. Minimal spotting from speculum use and cervical access may occur for the first 24hours, so wearing a liner is recommended.

To maximise healing benefit from the PRP therapy we recommend:

Immediately following PRP

Remain lying down for 10 minutes post procedure
You may notice some clear fluid leaking from the vagina post procedure - this is very normal
Spotting is also common - this is likely to be from accessing the cervix

First 12 hours after PRP

Not to wash the area with anything but water or apply any products
You may have spotting or bleeding after

First 24 hours after PRP

Nil intercourse.
Nil exercise that would create excessive perspiration for 24 hours
For 48 hours after the PRP procedure
No spas or swimming pools.
Minimal alcohol, coffee, caffeine; and nil supplements that may increase bruising
For patients who regularly take aspirin, you may resume it 48 hours after the procedure, unless otherwise directed by your Fertility Specialist

First 7 days after PRP

If you require pain relief, please use paracetamol or codeine only. Please do not use any anti-inflammatory medication (eg: Nurofen). Although the chance of an infection caused by the PRP procedure is extremely rare, please contact our rooms f you experience any signs of infection or fever. If you have an emergency after hours - please present to your local emergency department.

References

Amable P R et al. Platelet-rich plasma preparation for regenerative medicine: optimization and quantification of cytokimes and growth factors. Stem Cell Res Ther. 2013;4;65

Chang Y et al. Autologous platelet-rich plasma promotes endometrial growth and improves pregnancy outcome during in vitro fertilisation. Int J Clin Exp Med. 2015;8:1286-1290.

Kim H et al. Effect of autologous Platelet-Rich Plasma Treatment on Refractory thin endometrium during the frozen embryo transfer cycle: A pilot study. Front Endocrinol (Lousanne). 2019;10:61

Therapeutic Goods Adminstration. Regulation of platelet-rich plasma (PRP), platelet-rich fibrin (PRF) and conditioned serum. [Internet] https://www.tga.gov.au/resources/resource/guidance/regulation-platelet-rich-plasma-prp-platelet-rich-fibrin-prf-and-conditioned-serum