# APBA Kısa Özet
Hysteroscopic platelet-rich plasma (PRP) has been proposed as an adjuvant treatment in medically assisted reproduction. This systematic review synthesises the available evidence from three studies evaluating hysteroscopic PRP administration and its impact on clinically assisted reproduction outcomes. Study populations were heterogeneous and included women with refractory thin endometrium and/or a history of implantation failure. Hysteroscopic PRP administration protocols varied in timing, technique, and dosage.
# Çalışma neyi araştırdı?
This systematic review aimed to synthesise the available evidence on hysteroscopic PRP administration and its impact on clinical medically assisted reproduction (MAR) outcomes. A systematic search was conducted from inception to December 2025 across major databases. Studies were included if they evaluated hysteroscopic PRP administration in women undergoing MAR, comparing reproductive outcomes between treated and control groups. Out of 142 records, 3 studies met the inclusion criteria.
# Yöntem
The review followed systematic review methodology. A comprehensive search strategy was implemented across major databases from inception to December 2025. Studies were screened for eligibility based on predefined criteria: evaluation of hysteroscopic PRP administration in women undergoing medically assisted reproduction, comparison of reproductive outcomes between treated and control groups, and availability of outcome data. Out of 142 records identified, 3 studies met the inclusion criteria. Study populations were heterogeneous and included women with refractory thin endometrium and/or a history of implantation failure. Hysteroscopic PRP administration protocols varied in timing, technique, and dosage.
# Temel bulgular
# # Prospective case-control study
One prospective case-control study reported higher implantation, clinical pregnancy, and live birth rates with hysteroscopic intraendometrial PRP injection. The protocol involved intraendometrial PRP injection at a depth of 2-3 mm in the four uterine walls, using an ovum aspiration needle, on days 11-13 of the cycle prior to euploid frozen embryo transfer. Outcomes were significantly favouring the PRP group compared to standard therapy.
# # Observational study
An observational study evaluated a single intraendometrial PRP injection (35-40 mL, 2-3 mm depth) administered via endoscopic needle on days 6-8 of the menstrual cycle preceding frozen embryo transfer, alone or after electrical impulse therapy. No significant differences in clinical pregnancy rate, miscarriage rate, or live birth rate were observed between groups.
# # Randomised controlled trial in intrauterine insemination
A randomised controlled trial in women undergoing intrauterine insemination reported a significant improvement in clinical pregnancy rate following hysteroscopic subendometrial PRP instillation. The protocol involved 1.0 mL of PRP instilled in each of the four uterine walls.
# Bulgular ne anlama geliyor?
The included studies demonstrate considerable heterogeneity in PRP preparation, administration technique, timing, and patient populations. The prospective case-control study suggests a potential benefit of intraendometrial PRP administered at specific cycle days (11-13) before frozen embryo transfer, particularly in terms of implantation and live birth. The observational study found no significant benefit of a single PRP injection on clinical outcomes in a similar population. The RCT in intrauterine insemination reported improved clinical pregnancy rates with subendometrial instillation. Overall, the evidence remains imprecise and inconsistent across study designs.
# Klinik önem
Clinicians considering hysteroscopic PRP as an adjunct to medically assisted reproduction should be aware of the current evidence limitations. The potential benefit suggested by the prospective case-control study is promising but not yet conclusive. The lack of significant findings in the observational study and the specific protocol used in the RCT highlight the importance of standardised administration methods. Until robust evidence from large-scale randomised controlled trials with standardised protocols is available, hysteroscopic PRP should be viewed as an investigational adjunct rather than a standard clinical practice. Patients should be counselled about the uncertain efficacy and the need for further research.
# Sınırlılıklar
This systematic review has several limitations that must be considered when interpreting the findings. First, the included studies exhibited considerable heterogeneity in PRP preparation, administration technique, timing, and dosage. Second, the small number of studies (n=3) meeting the inclusion criteria limits the statistical power and generalisability of the results. Third, limited data prevent robust conclusions on the clinical effectiveness of hysteroscopic PRP. Fourth, variability in patient populations, including those with refractory thin endometrium and/or implantation failure, further complicates interpretation. Fifth, inconsistent results across studies underscore the need for further robust randomised controlled trials with standardised protocols. Finally, the risk of bias and indirectness of the included studies were assessed as unclear and indirect, respectively, affecting the precision and consistency of the evidence.