Platelet-rich plasma as an adjuvant therapy for intrauterine adhesions: a narrative review of mechanisms, clinical efficacy and combination strategies.

BACKGROUND

Intrauterine adhesions (IUA), particularly moderate to severe cases, is a leading cause of decreased menstrual flow and secondary infertility in women, affecting an estimated 2.8%∼46% of infertile women. Hysteroscopy remains the gold standard for diagnosis, with high sensitivity and specificity (both exceeding 90%), while three-dimensional ultrasonography offers a non-invasive alternative with a reported sensitivity of 86% and specificity of 90% for detecting intrauterine abnormalities. The success of surgical management via transcervical resection of adhesions (TCRA) is primarily gauged by the resumption of normal menstrual flow and the absence of significant adhesions on second-look hysteroscopy or ultrasonography. However, the high recurrence rate postoperatively, especially in severe cases (up to 60%), and the persistently thin endometrium significantly impair patients' reproductive outcomes. Existing adjuvant treatments such as high-dose oestrogen, uterine stents and hydrogels have failed to substantially improve patients' fertility outcomes. Platelet-rich plasma (PRP), as an autologous biological preparation rich in various growth factors, has demonstrated remarkable application prospects in recent years for the adjuvant and combined treatment of IUA due to its potent pro-angiogenic, anti-inflammatory and tissue repair/regeneration-promoting properties.

OBJECTIVE

This review aims to summarize the mechanisms and clinical efficacy of PRP as an adjuvant therapy for IUA, providing new perspectives for the comprehensive management of this condition.

DISCUSSION: We explore the mechanisms of action and clinical outcomes of PRP monotherapy following IUA surgery and evaluate the safety and application advantages of PRP and autologous PRP. The mechanisms of the synergistic effects of PRP combined with mesenchymal stem cells(MSCs), uterine scaffolds and hydrogels, as well as the efficacy of these combination therapies, were discussed. In most studies, favourable feedback was obtained, while a few studies suggested that PRP alone or in combination failed to improve the reproductive outcomes of IUA patients.

CONCLUSION

Current evidence suggests that PRP, both as a standalone and adjunctive therapy, shows promise in promoting endometrial regeneration and improving certain clinical outcomes, such as endometrial thickness and menstrual flow, in patients with IUA. However, the clinical efficacy remains inconclusive due to significant heterogeneity in study designs, patient populations and PRP preparation protocols. High-quality, large-scale randomized controlled trials with standardized methodologies and long-term follow-up are urgently needed to definitively establish its impact on critical reproductive outcomes, such as live birth rates, before its widespread clinical adoption can be recommended.