Association of intrauterine platelet-rich plasma infusion before embryo transfer with endometrial response and live birth: a cohort study

Background: Intrauterine platelet-rich plasma (PRP) has been proposed as an adjunctive intervention for patients with thin endometrium or recurrent implantation failure before embryo transfer, but evidence remains limited by heterogeneous protocols and small studies. Objective: To evaluate whether intrauterine PRP infusion before embryo transfer is associated with improved endometrial response and pregnancy outcomes, particularly live birth per embryo-transfer (ET) cycle. Methods: This retrospective cohort included 620 ET cycles, comprising 310 cycles exposed to intrauterine PRP before ET and 310 matched control cycles without PRP exposure. The primary outcome was live birth per ET cycle. Secondary outcomes included biochemical pregnancy, clinical pregnancy, ongoing pregnancy at 12 weeks, ectopic pregnancy, multiple pregnancy, endometrial-thickness response, triple-line endometrial pattern, conditional pregnancy progression, and delivery/neonatal outcomes. Pregnancy outcomes were analyzed using unadjusted and adjusted comparisons and multivariable models. Results: The PRP and control groups were similar in age, BMI, baseline endometrial thickness, endocrine parameters, frozen ET status, ICSI use, and single-embryo transfer. PRP-treated cycles had more prior IVF/ICSI cycles, clinician-recorded recurrent implantation failure, history of cavity-distorting fibroid, and history of hydrosalpinx. Baseline and pre-procedure endometrial thickness were similar between groups, but post-procedure endometrial thickness, ET-day endometrial thickness, and triple-line pattern were more favorable in the PRP group. In unadjusted analyses, PRP was associated with higher clinical pregnancy, ongoing pregnancy at 12 weeks, and live birth. Live birth occurred in 82/310 PRP cycles (26.5%) and 53/310 control cycles (17.1%) (risk ratio [RR], 1.55; 95% CI, 1.14-2.10; P = 0.005). After multivariable adjustment, PRP remained associated with live birth (adjusted RR, 1.55; 95% CI, 1.12-2.15; P = 0.009). Sensitivity analyses were directionally consistent. Conclusion: In this cohort study, intrauterine PRP infusion before ET was associated with improved endometrial development and higher rates of clinical pregnancy, ongoing pregnancy, and live birth.