Intrauterine infusion of autologous platelet-rich plasma improves pregnancy outcomes of patients with moderate to severe intrauterine adhesions undergoing frozen-thawed embryo transfer

Background The effectiveness of in vitro fertilization and embryo transfer remains limited in infertile women with moderate to severe intrauterine adhesions (IUA). Intrauterine infusion of autologous platelet-rich plasma (PRP) before embryo transfer has been reported to increase the endometrium thickness and clinical pregnancy rate in women with thin endometrium undergoing frozen-thawed embryo transfer (FET) cycles. This retrospective cohort study aims to investigate whether intrauterine autologous PRP infusion improves pregnancy outcomes of patients with moderate to severe IUA undergoing FET cycles. Materials and methods All consecutive FET cycles from November 2021 to December 2024 were screened for those in which moderate to severe IUA patients were treated with intrauterine autologous PRP infusion during endometrial preparation. Propensity score matching based on age and serum anti-Müllerian hormone levels was performed to select control patients without PRP infusion. The primary outcome was live birth. Multivariate logistic regression analysis was performed to adjust for confounding bias. Results A total of 180 cycles were included in this study, with 90 cycles in the PRP group and 90 cycles in the control group. The rates of live birth (36.7% vs. 20.0%, P = 0.013), clinical pregnancy (44.4% vs. 27.8%, P = 0.020), and implantation (30.8% vs. 17.3%, P = 0.006) were significantly higher in the PRP group than in the control group. Although not statistically significant, a trend was observed toward a lower early miscarriage rate in the PRP group compared to the control group (15.0% vs. 24.0%, P = 0.561). A positive association was found between live birth and intrauterine autologous PRP infusion (OR = 2.080, 95% CI 1.035–4.183, P = 0.040) after adjusting for confounding variables. Conclusions Intrauterine autologous PRP infusion during FET cycles can markedly improve pregnancy outcomes of patients with moderate to severe IUA.