Autologous Intrauterine Platelet Rich Plasma Versus G-CSF instillation for Improvement of Endometrial Growth and Vascularity in Recurrent in Vitro Fertilization Failure

Background: in vitro fertilization [IVF] is an expensive, cumbersome yet most successful treatment for infertility. Inspite of its success, at the most 40% of the procedure only result in good outcome. Often at times which can be very frustrating and disappointing journey for the couple as well as the clinicians who despite of strict adherence to treatment protocols fail to produce result, it is mostly attributed to implantation failure, which is mostly due to poor receptivity of the endometrium. Several treatments ranging from chinese acupuncture to hormones to endometrial injury all have been treat with not definitive treatment. Autologous platelet rich plasma (PRP) and G-CSF have come up to be exciting new therapy in that aspect. In neutrophilic granulocytes, platelet-rich plasma (PRP) has been shown to increase endometrial development and receptivity, whilst G-CSF has been shown to promote the growth of stem cells and progenitor cells. This study offers an intriguing perspective on the two medications in comparison.

Materials and Methods: It is a prospective ,cross-sectional, single blind study, conducted over a period of 6 months in 25 women who had failed to conceive after one or more embryo transfers with high-quality embryoswomen having a poor endometrial pattern, as defined by an endometrial thickness of less than 7mm despite conventional treatment with estradiol valerate (up to 12 mg/day), or suboptimal endometrial vascularity, defined as < zone 2 as determined by applebaum's criteria, success of which was measured in number of clinical pregnancies resulted.

Results: The mean PRP endometrial thickness was 5 mm which significantly increased to 7.34 mm post platelet rich plasma, against post-G-CSF endometrial thickness was 8.02 mm from 6.03mm pre infusion. Out of 10 cases who were infused with PRP,7 of them showed good vascularity (more than or equal to zone 3)out of 10 of those were given G-CSF,5 of them showed good vascularity. Number of clinical pregnancies resulted after instillation of PRP were 4 while 3 in case of G-CSF group.

Conclusion: It can be concluded that although both PRP and G-CSF are equally effective in increasing endometrial thickness but endometrial vascularity is better inproved with platelet rich plasma, clinical pregnancy rates were also better with PRP but being a small sample study it was not significant statistically.