Лечение тонкого эндометрия путем гистероскопической инстилляции плазмы, обогащенной тромбоцитами, в эндомиометриальный переход пилотное исследование

Abstract

Abstract___________________________________________________________________________

Introduction. Endometrial thickness ≥7 mm is considered optimal for embryo transfer. Thin endometrium reduces the chances of implantation due to poor vascularization and low VEGF expression. Treatment with estrogens, aspirin, sildenafil and other agents gives limited results. A promising method is the intrauterine administration of PRP - plasma rich in platelets and growth factors (VEGF, EGF, PDGF, TGF) that stimulate angiogenesis and proliferation. The endometrium regenerates due to stem and progenitor cells (eMSC, eEP). Hysteroscopic administration of PRP improves the condition of the endometrium with its poor response to standard therapy.

Purpose. To evaluate the efficacy of hysteroscopic instillation of platelet-rich plasma (PRP) into the endometrial junction to improve endometrial thickness and subendometrial blood flow in women with repeated cancelled embryo transfer cycles due to thin endometrium (≤7 mm) despite prior estrogen therapy, intrauterine PRP and G-CSF.

Materials and methods. The study included 32 infertile women (27–39 years old) who underwent hysteroscopic PRP instillation at the clinic of Samarkand State Medical University. Inclusion criteria: endometrial thickness ≤7 mm in previous cycles, frozen embryo transfer, normal pelvic ultrasound results, absence of genital tuberculosis. Efficiency was assessed by increasing the endometrial thickness (>7 mm) and the onset of pregnancy.

Results. Hysteroscopic PRP instillation resulted in an endometrial thickness of ≥7 mm in 75% of patients and improved subendometrial blood flow in 87.5%, which allowed embryo transfer in 24 women. Clinical pregnancy occurred in 10 of them (41.6%), and the method was safe and well tolerated.

Conclusion. Thin endometrium remains one of the key problems in the practice of assisted reproductive technologies and causes serious difficulties in choosing an effective treatment strategy. The method of hysteroscopic PRP instillation developed in our center demonstrated encouraging results, opening up new prospects for the use of PRP in women with infertility and previously canceled embryo transfer cycles due to insufficient endometrial thickness.