Platelet rich plasma for assisted reproduction: an overview of systematic reviews

Abstract

Background - In recent years, platelet-rich plasma (PRP) has been used to improve endometrial receptivity in infertile women undergoing assisted reproduction. This article aims to review the literature and critically appraise the available evidence regarding the efficacy of PRP for assisted reproduction.

Materials and methods - An overview of systematic reviews (SRs) (umbrella review) of PRP use for assisted reproduction. The methodological quality of the SRs was assessed using the AMSTAR-2 checklist; quality of the evidence from the trials included in each SR was appraised following the GRADE approach.

Results - Twenty-five SRs published between 2020 and 2024 were included in this overview. The SRs reported data from 306 overlapping reports based on 112 individual primary studies. The overlap among primary studies was slight across all reports included (CCA index 1.9%). With the AMSTAR 2 tool, the SRs showed only some non-critical weakness, but no critical flaws. Thus, confidence in the results of the SRs can be considered high or moderate. Clinical pregnancy rate was reported in 17 SRs, chemical pregnancy in 8, implantation rate in 8, and live birth rate in 16 SRs. Almost uniformly the SRs showed increased rates of positive outcomes in PRP recipients compared to controls (from very low to high certainty of evidence). Miscarriage rate, ectopic pregnancy and multiple pregnancy, reported in some of the SRs, resulted uncertainty about the effect of PRP infusion compared with no intervention on these outcomes (no statistically significant differences between groups).

Discussion - The evidence from SRs shows beneficial effects of PRP compared to controls in terms of clinical and chemical pregnancy rates, implantation rates and live birth rates. The level of evidence varied from very low to high (more commonly low or moderate) in relation to methodological flaws and clinical heterogeneity of primary studies included in the SRs.