New applications of platelet-rich plasma in gynecology

Dear Editorial Board,

I am reaching out to draw attention to new applications of platelet-rich plasma (PRP) in gynecology, particularly its intrauterine application and intraovarian injections.

The use of PRP has gained significant attention over the past decade due to its ability to promote tissue regeneration by facilitating cell differentiation and stimulating trophic activity. Platelet-rich plasma is widely used to enhance healing and regeneration in various medical fields, such as orthopedics, dentistry, dermatology, plastic surgery, the care of patients with diabetes-related complications, cardiac surgery and cesarean sections [1]. In gynecology, PRP has been applied in the treatment of stress urinary incontinence and genital rejuvenation [2]. Particularly intriguing are the emerging PRP applications in gynecology, such as intrauterine administration and intraovarian injections [3].

Intrauterine PRP application has been used for conditions such as Asherman’s syndrome, which involves damage to the basal endometrial layer and the formation of intrauterine adhesions, as well as for chronic endometritis and patients undergoing in vitro fertilization (IVF) with a non-receptive endometrium. Aghajanova et al., in their study *Autologous Platelet-Rich Plasma Treatment for Moderate-Severe Asherman’s Syndrome: The First Experience*, were the first to report intrauterine PRP infusion in humans. The study included 15 patients with Asherman’s syndrome who received autologous PRP via a Wallace IUI catheter immediately upon adhesiolysis, along with a control group of 15 patients. While no statistically significant difference in conception success was observed due to the small sample size, the study effectively demonstrated the safety and feasibility of intrauterine PRP administration [3]. Liu et al. conducted a meta-analysis suggesting that intrauterine application of autologous PRP may be an effective therapeutic approach for thin endometrium, as it increases endometrial thickness in affected patients, improves pregnancy outcomes, and is free of adverse effects [4].

Intraovarian PRP injections are used for premature ovarian insufficiency (POI) and menopause, aiming to prevent ovarian atresia and stimulate the growth of primordial and preantral follicles. Cakiroglu et al. recruited 311 women with POI for intraovarian autologous PRP injections. After six weeks, spontaneous pregnancy occurred in 23 patients (7.4%), while among the remaining 201 women, 70% developed at least one antral follicle following PRP treatment [5]. Elias’s meta-analysis, which represents the most extensive scientific review to date (primarily based on observational studies), demonstrated that ovarian PRP treatment led to a statistically significant improvement in key fertility parameters among women with diminished ovarian reserve, including antral follicle count, anti-Müllerian hormone (AMH), follicle-stimulating hormone (FSH), and luteinizing hormone (LH) levels [6].

Although PRP application to the ovaries and endometrium has shown promising results in patients with low ovarian reserve or a non-receptive endometrium, as well as in established gynecological indications such as wound healing, lichen sclerosus, vulvodynia, and stress urinary incontinence, several challenges remain in standardizing the method. These include individual variations in platelet counts and growth factor content, variability in indications, and a large number of different PRP preparation protocols. It is also important to note that certain patients are not suitable candidates for this method, including those with malignant diseases, acute infections, coagulation disorders, and autoimmune diseases. I believe these methods warrant greater attention in our country and require further validation through large, multicenter studies conducted with rigor and long-term follow-up to confirm their efficacy.

Best regards,
Mr. Sci. Dr. Mirjana Anđelić,
Specialist in Gynecology and Obstetrics, Subspecialist in Fertility and Sterility