The value of platelet rich plasma in women with intrauterine adhesions. A systematic review and meta-analysis

To evaluate the benefits of platelet-rich plasma administration after adhesiolysis in women with intrauterine adhesions. A database search using the keywords (autologous platelet-rich plasma) AND (intrauterine adhesions) and their Medical Subject Headings terms revealed 11 studies with 1,130 participants. Endometrial thickness was reported in four studies with 274 participants. The mean difference effect estimate was 0.53 with a 95% confidence interval (CI) of 0.23, 0.82; P<0.001, and I²=0%. The menstrual pattern after the procedure showed that the odds ratio (OR) effect estimates for amenorrhea, hypomenorrhea, and normal menstruation were 6.47 (0.24, 174.08), 0.84 (0.41, 1.73), and 1.21 (0.51, 2.84), respectively, and the P-values were 0.27, 0.63, and 0.66, respectively. The number of women with adhesions after the procedure showed that the OR effect estimates for grade I, II, and III adhesions were 1.74 (0.41, 7.45), 0.76 (0.21, 2.70), and 0.31 (0.11, 0.88), respectively, and the P-values were 0.46, 0.67, and 0.03, respectively. Changes in the American Fertility Society (AFS) score after the operation were reported in three studies with 276 participants. The mean difference effect estimate was 0.87, with a 95% CI of 0.17, 1.56; P=0.01; I²=0%. The clinical pregnancy rate was reported in five studies involving 506 participants. The OR effect estimate was 1.80 with a 95% CI of 1.18, 2.75; a P-value of 0.006, and I² of 0%. Platelet-rich plasma administration after hysteroscopic adhesiolysis improved endometrial thickness (low evidence), recurrence of grade III adhesions (low evidence), AFS score of adhesions (low evidence), and clinical pregnancy rates (moderate evidence).