Hysteroscopic Installation of Autologous Platelet Rich Plasma in Infertile Women Having Thin Endometrium Undergoing IUI -RCT

Abstract

Objective: To evaluate whether hysteroscopic-guided intrauterine platelet-rich plasma (PRP) with estradiol improves endometrial thickness and vascularity, and increases pregnancy rates, versus estradiol alone in women with thin endometrium undergoing intrauterine insemination (IUI). Design: Prospective randomized case–control study at a tertiary teaching hospital. Patients: 120 women (21–37 years) with prior cycles showing endometrium <7 mm were randomized equally to PRP+estradiol (n=60) or estradiol alone (n=60). Methods: Baseline TVS and power Doppler were performed; PRP was prepared autologously and instilled under hysteroscopic guidance prior to IUI. Outcomes were endometrial thickness (ET), Doppler pulsatility/resistance indices (PI/RI), and pregnancy (UPT positive and ultrasound-confirmed). Results: Baseline ET was comparable (mean 4.60 mm vs 4.92 mm; p=0.612). After treatment, mean ET gains in PRP+estradiol were 1.46 mm (cycle-1), 3.01 mm (cycle-2), and 4.26 mm (cycle-3) (all p<0.001), exceeding estradiol alone: 0.11 mm, 0.37 mm, 0.78 mm, respectively. PI/RI changes favored PRP across cycles. Conceptions occurred in 4, 12, and 14 patients across cycles 1–3 (PRP) versus 0, 0, and 10 (control). Conclusion: Intrauterine PRP with estradiol significantly improves ET and endometrial vascular indices and yields higher conception counts versus estradiol alone in thin endometrium IUI cycles.