الفهرس 
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Abstract
This study was a prospective randomized controlled trial that involved 160 women who had a history of repeated implantation failure. The study was conducted at the Elnile reproductive center from May 2021 to August 2023. The participants were between the ages of 18 and 40, had a BMI of less than 30 kg/m2, and had a normal uterine cavity established within the past 12 months using a hysteroscopy. Prior to conducting the study, approval was obtained from the Institutional Ethical Committee, and written informed consent was obtained from all participants.
The aim of this study is to evaluate whether intrauterine infusion of autologous platelet rich plasma (PRP) in patients with prior recurrent implantation failure improves implantation and prevent RIF or not.
The patients were randomly assigned to 2 equal groups by using a computer-generated table and randomization sequence into: Controlled group, which include 80 women with RIF and does not receive intrauterine PRP. PRP group, which include 80 women with RIF and receive 1ml of intrauterine PRP 48 h before embryo transfer in frozen thawed cycle.
After hormonal replacement therapy for endometrial preparation prior to frozen embryos transfer following programmed/artificial cycle (AC) protocol as follow: estradiol valerate 6 mg/d was started orally from 2nd or 3rd day of menstrual cycle. Patients were scanned by transvaginal ultrasound to evaluate the thickness of the endometrium. The evaluation of endometrial thickness has been the subject of extensive scrutiny in order to provide a precise definition of an optimum endometrium. In the event that the endometrium did not reach a satisfactory thickness, the dosage of estradiol could be adjusted to 8 mg/d until improvement of the endometrial thickness. Upon reaching the optimal endometrial thickness that estimated at least 8 mm, progesterone suppository 400 mg twice daily was started and continued for duration of 4 days.
Two weeks following ET, progesterone and estradiol valerate supplementation were maintained. In the event that (β-HCG) test was positive, these hormonal supplements were administered until twelve weeks of gestation
PRP was prepared by withdrawing (15-20 ml) venous blood from the anti-cubital vein by venipuncture in blue capped tubes contain Na citrate as anticoagulant solution or tubes contain Acid Citrate A solution. Samples are centrifuged in a refrigerated centrifuge immediately after collection at 1,200 rpm for 12 min (the soft spin). The purpose of this procedure is to isolate the RBC from plasma. To omit activation of the platelet during the procedure, it is advised to maintain a temperature range of 21-24°C. The blood undergoes separation into three distinct layers: an upper layer which contains platelets and WBC, an intermediate thin layer (the buffy coat) which rich in WBCs, and a bottom layer which contains RBCs. The upper and intermediate buffy layers are transferred to an empty sterile tube. Plasma is then transferred into a sterile falcon tube and again centrifuged at 3300 rpm for duration of 7 min (the hard spin). In order to create a concentrated form of platelets, the platelet-poor plasma in the supernatant is discarded, while the platelet pellet that has formed at the bottom of the tube is collected. 1 ml PRP is now ready for injection.
Infusion of 1 ml PRP was given under ultrasound guidance 2 days before frozen-thawed embryo transfer for women in the study group.
Embryos with good quality were transferred under ultrasound guidance.
All patients were assessed as follow:
• Endometrial thickness improvement at time of frozen embryo transfer.
Occurrence of pregnancy evidenced by positive β-hCG measured 2 weeks after ET and it is considered positive for level ≥ 5 IU.
Implantation that evidenced by number of gestational sacs seen at 2-3 weeks subsequent FET.
Clinical pregnancy that evidenced by detecting the viable intrauterine pregnancy, 5-6 weeks from FET through visualization of intrauterine gestational sac and fetal pole with a heartbeat on an ultrasound.
The findings of our study indicate a statistically significant difference in the chemical pregnancy rate between the PRP group and the control group (55% vs 28.8%, p=0.001). The study findings revealed a notable increase in the clinical pregnancy rate among participants in the platelet-rich plasma (PRP) group compared to the standard group (30% vs 14%, p=0.004). So, we conclude that the intrauterine infusion of PRP has a beneficial impact on pregnancy outcomes in patients with recurrent implantation failure.