(A-PRP) in Unexplained Infertility: A Revolution in Reproductive Medicine
Any treatment for unknown infertility is empiric by default, and the broad range of treatment, including expectant management, superovulation, IUI, IVF and IVF–intracytoplasmic sperm injection, reflects the uncertainty with this diagnosis. There are limited data to support the efficacy of many of these treatments, and no uniform protocol exists in clinical practice. Autologous platelet rich plasma (A-PRP) can be a novel technique which has never been explored before much in this field.
To compare autologous platelet rich plasma with expectant management in cases of unexplained infertility.
All cases (50) of primary unexplained infertility were treated with either A-PRP or by expectant management on the basis of their endometrial thickness (7mm). All cases of thin endometrium (<7mm) were subjected to A-PRP (25 cases). Whereas rest of the cases (25 in number) was monitored as per expectant management protocol for a maximum of three cycles after which they were switched over to being treated with PRP. The main outcomes measured were number of follicles, endometrial thickness, pregnancy rate and miscarriage rates. The statistical analysis was evaluated with IBM SPSS Statistics for Windows, Version 24.0, IBM Corp, and Chicago, IL.
Out of 46 patients, 25 patients (54.35%) got conceived with a single dose of intra-uterine autologous platelet rich plasma injection, which was found to be statistically highly significant. The correlation analysis with Spearman’s Rank correlation coefficient (rho ρ) was 0.891 which show highly positive correlation between intra-uterine autologous platelet rich plasma injection and pregnancy rate and 0.247 which show weakly positive correlation between expectant management and pregnancy rate.
Autologous platelet rich plasma (A-PRP) is a novel technique than can treat unexplained infertility with favorable outcomes.
Unexplained or idiopathic infertility, constituting 30% of infertile couples worldwide, is defined as the lack of an obvious cause for a couple's infertility and the females’ inability to get pregnant after at least 12 cycles of unprotected intercourse or after six cycles in women above 35 years of age for whom all the standard evaluations are normal. Any treatment for unknown infertility is empiric by default, and the broad range of treatment, including expectant management, superovulation, IUI, IVF and IVF–intracytoplasmic sperm injection, reflects the uncertainty with this diagnosis. Several key variables including age, infertility history, treatment history, costs, and risks should be considered in selection of the suitable treatment plan. However, there are limited data to support the efficacy of many of these treatments, and no uniform protocol exists in clinical practice.
The rate of spontaneous conception in these couples is more than the couples with defined causes of infertility and several studies have reported that the rate of spontaneous pregnancy was 13-15% during the first year of attempt which increased to 35% during the next two years. Moreover, the rate could reach 80% in younger couples during the following three years of unprotected intercourse without any adjuvant therapy. Thus, the best plan for them would be expectant management.
Factors including lack of strong clinical evidence, couple’s impatience for completion of standard protocols and dominance of ART treatment compared to other options lead to diversity of clinical practice regarding unexplained infertility. Often the clinicians offer additional expensive and experimental tests which waste the golden time of couples for pregnancy without any effective results.
Extensive research in reproductive biology and increasing our knowledge of gametogenesis, fertilization, embryo development, and endometrium-implantation and fetus-uterus crosstalk can provide more effective treatment options in future for infertile couples specially the ones with unexplained infertility.
Autologous platelet rich plasma (A-PRP) can also be referred as Regenerative Concentrate of Active Plasma (R-CAP), which is defined as the volume of plasma with an exponentially increased platelet concentration of 5-6 times above the baseline (106- 107/mL). Platelet contains alpha granules which provides various growth factors which stimulates biological healing, homeostasis and tissue rejuvenation by a supra-physiological release of biological micro molecules at the site of the injection. It, being injected in the uterine cavity and its effects on endometrial receptivity, has been an upcoming topic of research dealt very little in the field of reproductive medicine. Hence, the need for this study.
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Journal of Clinical Trials