Endometrial Autologous Intrauterine Platelet-Rich Plasma (PRP) Instillation Treatment and Its Potential on In Vitro Fertilization (IVF): Narrative Review.

Implantation failure remains a major challenge in assisted reproductive technology, particularly in women with thin endometrium, repeated implantation failure (RIF), Asherman's syndrome (AS), or chronic endometritis (CE). In recent years, autologous intrauterine platelet-rich plasma (PRP) has been proposed as a regenerative approach aimed at improving endometrial receptivity through the local release of growth factors, cytokines, and angiogenic mediators. A narrative review of the literature published between 2015 and 2021 was performed using PubMed, Google Scholar, and Web of Science. Studies assessing intrauterine PRP administration in women undergoing assisted reproduction were included. Due to the limited availability of high-quality randomized evidence, data from a wide range of study designs-including randomized controlled trials, observational studies, pilot studies, and case reports-were reviewed in order to reflect current clinical experience. Reported outcomes included endometrial thickness, implantation rate, clinical pregnancy rate, and live birth rate in patients with thin endometrium, RIF, AS, and CE. Most studies described an association between PRP administration and improvements in endometrial thickness, vascularity, implantation, and clinical pregnancy rates. In women with thin endometrium, PRP was frequently associated with an increase in endometrial thickness to at least 7 mm and improved reproductive outcomes. In cases of repeated implantation failure, some randomized controlled trials suggested higher pregnancy and implantation rates in PRP-treated patients compared with controls. Evidence regarding AS and CE was largely derived from case reports and small case series, reporting enhanced endometrial regeneration and occasional successful pregnancies. Overall, intrauterine PRP appears to be a promising and well-tolerated autologous intervention for women with poor prognostic factors. Nevertheless, the available evidence remains preliminary, and further large-scale randomized controlled trials using standardized PRP preparation and administration protocols are required to clarify its effectiveness and define its role in evidence-based assisted reproduction.