Platelet-rich plasma in the management of Asherman's syndrome; An RCT

Abstract

Background: Asherman’s syndrome (AS) is a rare reproductive abnormality, resulting in endometrial collapse due to aggressive or recurrent endometritis and/or curettage.
 Objective: We aimed to assess the effectiveness of using platelet-rich plasma (PRP) to lower the recurrence rate of intrauterine adhesions (IUAs) following postlysis hysteroscopy.
 Materials and Methods: In a nonrandomized controlled study, women aged 20-45 years with AS diagnosed by sonohysterography, 3D sonography, hysteroscopy, or uterosalpingography between May 2018 and September 2018 were included. Patients (n = 30) were divided into case and control groups. Following hysteroscopic adhesiolysis, a Foley catheter was placed into the uterine cavity in all women. After two days, the catheter was removed, and 1-mL PRP was injected into the uterine cavity of women in the PRP (case) group, while the control received no PRP. All controls and subjects underwent diagnostic hysteroscopy 8-10 weeks following the intervention to assess the IUAs according to the American Society for Reproductive Medicine scoring system.
 Result: Our results did not reveal any significant difference in the menstrual pattern of either the control or test groups before or after treatment (p = 0.2). Moreover, the IUA stage in both studied groups before and after treatment was similar (p = 0.2). The duration of menstrual bleeding in both studied groups before and after treatment was also similar.
 Conclusion: PRP cannot decrease the menstrual pattern or development of postsurgical IUAs, as evaluated by follow-up hysteroscopy.
 Key words: Asherman’s syndrome, Platelet-rich plasma, Pregnancy rate.

Strategies for managing Asherman's syndrome and endometrial atrophy: Since the classical experimental models to the new bioengineering approach

“…These results suggest that the umbilical cord could be a good source of plasma for treating endometrial pathologies and other regenerative medicine applications, as demonstrated by other groups (Castellano et al, 2017;Ehrhart et al, 2018). PRP has also been tested in women with either thin endometrium (Chang et al, 2019;Eftekhar et al, 2018;Kim, Shin et al, 2019;Molina et al, 2018;Nazari et al, 2016;Tandulwadkar et al, 2017) or AS (Javaheri et al, 2020;Zadehmodarres et al, 2017). However, not all these human works presented a robust study design.…”

“…However, not all these human works presented a robust study design. From the results obtained by those conducted as clinical trials (Chang et al, 2019;Eftekhar et al, 2018;Javaheri et al, 2020;Tandulwadkar et al, 2017), it could be concluded that PRP is an effective therapeutic option for treating patients with thin endometrium in which the cause is not IUA (this was an exclusion criterion in the majority of existing studies).…”

Platelet rich plasma following hysteroscopic adhesolysis: a randomized clinical trial

“…On the contrary, the other study didn't find any significant difference regarding menstrual pattern, duration of menstrual bleeding, and IUAs stage. 21 This study used 1-mL PRP injected into the uterine cavity two days following adhesolysis and after removal of intrauterine balloon.…”

Biomimetics for treatment of endometrial pathologies: an overview

“…There are also studies in which the authors did not show that intrauterine PRP injection improves the results of hysteroscopy after surgical removal of intrauterine adhesions [43].…”