The effect of intrauterine platelet-rich plasma infusion on pregnancy outcomes in patients with recurrent implantation failure

Abstract

Abstract Does intrauterine platelet-rich plasma (PRP) infusion improve frozen embryo transfer (FET) outcomes in patients with recurrent implantation failure (RIF)? which patient subgroups benefit most significantly? This retrospective study (July 2023-March 2025) analyzed 1,846 frozen embryo transfer (FET) cycles from patients under 40 with ≥ 3 previous implantation failures. Pregnancy outcomes were compared between the PRP group (571 cycles) and the control group (1,275 cycles). Generalized Estimating Equations (GEE) analysis were employed to assess the independent effect of PRP infusion on live birth rate (LBR) in the overall cohort and prespecified subgroups. The LBR was significantly higher in the PRP group than the control group after adjusting for confounding factors (33.8% vs. 28.5%, adjusted OR 1.317, 95%CI 1.045–1.659). Stratified GEE analyses were conducted according to the maternal age, number of previous embryo transfer failures, whether to perform preimplantation genetic testing (PGT), infertility type and transferred embryo stage. After adjustment, the PRP group demonstrated a significantly higher LBR among patients of advanced-age (31.3% vs. 25.3%, adjusted OR 1.421, 95% CI 1.019–1.983) and those with secondary infertility (31.4% vs. 23.9%, adjusted OR 1.499, 95%CI 1.005–2.237). No significant differences were detected in the remaining subgroups. Among patients receiving PRP infusion, a declining trend in LBR was observed with extended PRP cryopreservation time. In this retrospective study, intrauterine PRP infusion was associated with significantly higher LBR in the overall RIF population. However, this beneficial association was not uniform and was primarily concentrated in women of advanced maternal age and those with secondary infertility.