Efecto del tratamiento con plasma autólogo rico en plaquetas en pacientes con endometrio delgado
Palabras clave:
transferencia de embriones congelados, plasma rico en plaquetas, endometrio delgado, espesor del endometrio.Resumen
Introducción: El éxito de los ciclos de transferencia de embriones congelados depende de una delicada interacción entre la calidad del embrión y el endometrio. Las bajas tasas de embarazo están asociadas con un endometrio delgado.Objetivo: Evaluar el efecto del tratamiento con plasma rico en plaquetas autólogo en pacientes con endometrial delgado.
Métodos: En 34 pacientes con endometrio delgado (< 7 mm) canceladas en los ciclos previos de transferencia de embriones congelados, se preparó plasma autólogo rico en plaquetas, a partir de sangre autóloga de venas periféricas; la infusión intrauterina se administró durante la terapia de reemplazo hormonal en los ciclos de transferencia de embriones congelados. La transferencia de embriones congelados se realizó cuando el grosor del endometrio alcanzó ≥ 7 mm.
Resultados: En 6s pacientes se canceló el ciclo de transferencia embrionaria debido a que el grosor del endometrio no alcanzó los 7 mm; 28 pacientes obtuvieron un grosor endometrial ≥ 7 mm y realizaron transferencia de embriones congelados. El grosor del endometrio fue de 7,5 ± 0,8 mm, significativamente mayor que en los ciclos anteriores (5,6 ± 0,79 mm) con p< 0,002; la tasa de implantación fue de 23,07 % y la tasa de embarazo clínico fue de 12/28 (42,8 %).
Conclusión: El plasma autólogo rico en plaquetas mejora el grosor endometrial y los resultados de la tasa de embarazo en mujeres con endometrio delgado.
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17. Alsousou J, Thompson M, Hulley P, Noble A, Willett K. The biology of platelet-rich plasma and its application in trauma and orthopaedic surgery: a review of the literature. The Journal of Bone and Joint Surgery. 2009; 91(8): 987-96. DOI: 10.1302/0301-620x.91b8.22546
18. Malahias MA, Chytas D, Babis GC, Nikolaou VS. Platelet-rich plasma guided injections: clinical application in peripheral neuropathies. Front Surg. 2014; 1:41. DOI: 10.3389/fsurg.2014.00041
19. Gato-Calvo L, Magalhaes J, Ruiz-Romero C, Blanco FJ, Burguera EF. Platelet-rich plasma in osteoarthritis treatment: review of current evidence. Ther Adv Chronic Dis. 2019; 10: 2040622319825567. DOI: 10.1177/2040622319825567
20. Samadi P, Sheykhhasan M, Khoshinani HM. The Use of Platelet-Rich Plasma in Aesthetic and Regenerative Medicine: A Comprehensive Review. Aesthetic Plast Surg. 2019; 43(3): 803-14. DOI: 10.1007/s00266-018-1293-9
21. Yuan T, Guo SC, Han P, Zhang CQ, Zeng BF. Applications of leukocyte- and platelet-rich plasma (L-PRP) in trauma surgery. Curr Pharm Biotechnol. 2012; 13(7): 1173-84. DOI: 10.2174/138920112800624445
22. Alio JL, Arnalich-Montiel F, Rodriguez AE. The role of "eye platelet rich plasma" (E-PRP) for wound healing in ophthalmology. Curr Pharm Biotechnol. 2012; 13(7): 1257-65. DOI: 10.2174/138920112800624355
23. Chicharro-Alcantara D, Rubio-Zaragoza M, Damia-Gimenez E, Carrillo-Poveda JM, Cuervo-Serrato B, Pelaez-Gorrea P, et al. Platelet Rich Plasma: New Insights for Cutaneous Wound Healing Management. J Funct Biomater. 2018; 9(1): [aprox. 20 p.]. DOI: 10.3390/jfb9010010
24. Mahajan N, Sharma S. The endometrium in assisted reproductive technology: How thin is thin? J Hum Reprod Sci. 2016; 9(1): 3-8. DOI: 10.4103/0974-1208.178632
25. Zadehmodarres S, Salehpour S, Saharkhiz N, Nazari L. Treatment of thin endometrium with autologous platelet-rich plasma: a pilot study. JBRA Assist Reprod. 2017; 21(1): 54-6. DOI: 10.5935/1518-0557.20170013
26. Eftekhar M, Neghab N, Naghshineh E, Khani P. Can autologous platelet rich plasma expand endometrial thickness and improve pregnancy rate during frozen-thawed embryo transfer cycle? A randomized clinical trial. Taiwan J Obstet Gynecol. 2018; 57(6): 810-3. DOI: 10.1016/j.tjog.2018.10.007
27. Chang Y, Li J, Chen Y, Wei L, Yang X, Shi Y, et al. Autologous platelet-rich plasma promotes endometrial growth and improves pregnancy outcome during in vitro fertilization. Int J Clin Exp Med. 2015; 8(1): 1286-90. [access: 07/05/2021]. Available in: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4358582/pdf/ijcem0008-1286.pdf
28. Kim H, Shin JE, Koo HS, Kwon H, Choi DH, Kim JH. Effect of Autologous Platelet-Rich Plasma Treatment on Refractory Thin Endometrium During the Frozen Embryo Transfer Cycle: A Pilot Study. Front Endocrinol (Lausanne). 2019; 10: 61. DOI: 10.3389/fendo.2019.00061
2. Mouhayar Y, Sharara FI. Modern management of thin lining. Middle East Fertility Society Journal. 2017;22(1):1-12. DOI: 10.1016/j.mefs.2016.09.001
3. Patel AN, Park E, Kuzman M, Benetti F, Silva FJ, Allickson JG. Multipotent menstrual blood stromal stem cells: isolation, characterization, and differentiation. Cell transplantation. 2008; 17(3): 303-11. DOI: 10.3727/096368908784153922
4. Richter KS, Bugge KR, Bromer JG, Levy MJ. Relationship between endometrial thickness and embryo implantation, based on 1,294 cycles of in vitro fertilization with transfer of two blastocyst-stage embryos. Fertility and sterility. 2007; 87(1): 53-9. DOI: 10.1016/j.fertnstert.2006.05.064
5. Kasius A, Smit JG, Torrance HL, Eijkemans MJ, Mol BW, Opmeer BC, et al. Endometrial thickness and pregnancy rates after IVF: a systematic review and meta-analysis. Hum Reprod Update. 2014; 20(4): 530-41. DOI: 10.1093/humupd/dmu011
6. Check JH, Dietterich C, Check ML, Katz Y. Successful delivery despite conception with a maximal endometrial thickness of 4 mm. Clin Exp Obstet Gynecol. 2003; 30(2-3): 93-4. [access: 11/04/2021]. Available in: https://www.imrpress.com/journal/CEOG/30/2-3/pii/2003021
7. Dix E, Check JH. Successful pregnancies following embryo transfer despite very thin late proliferative endometrium. Clin Exp Obstet Gynecol. 2010; 37(1): 15-6. [access: 09/05/2021]. Available in: https://www.imrpress.com/journal/CEOG/37/1/pii/1630629613826-507173421/pdf
8. Kumbak B, Erden HF, Tosun S, Akbas H, Ulug U, Bahceci M. Outcome of assisted reproduction treatment in patients with endometrial thickness less than 7 mm. Reprod Biomed Online. 2009; 18(1): 79-84. DOI: 10.1016/s1472-6483(10)60428-2
9. El-Toukhy T, Coomarasamy A, Khairy M, Sunkara K, Seed P, Khalaf Y, et al. The relationship between endometrial thickness and outcome of medicated frozen embryo replacement cycles. Fertility and sterility. 2008; 89(4): 832-9. DOI: 10.1016/j.fertnstert.2007.04.031
10. Chen MJ, Yang JH, Peng FH, Chen SU, Ho HN, Yang YS. Extended estrogen administration for women with thin endometrium in frozen-thawed in-vitro fertilization programs. Journal of Assisted Reproduction and Genetics. 2006; 23(7-8): 337-42. DOI: 10.1007/s10815-006-9053-1
11. Khairy M, Banerjee K, El-Toukhy T, Coomarasamy A, Khalaf Y. Aspirin in women undergoing in vitro fertilization treatment: a systematic review and meta-analysis. Fertility and sterility. 2007; 88(4): 822-31. DOI: 10.1016/j.fertnstert.2006.12.080
12. Gutarra-Vilchez RB, Bonfill Cosp X, Glujovsky D, Viteri-Garcia A, Runzer-Colmenares FM, Martinez-Zapata MJ. Vasodilators for women undergoing fertility treatment. Cochrane Database Syst Rev. 2018; 10: CD010001. DOI: 10.1002/14651858.CD010001.pub3
13. Takasaki A, Tamura H, Miwa I, Taketani T, Shimamura K, Sugino N. Endometrial growth and uterine blood flow: a pilot study for improving endometrial thickness in the patients with a thin endometrium. Fertility and sterility. 2010; 93(6):1851-8. DOI: 10.1016/j.fertnstert.2008.12.062
14. Miralaei S, Ashrafi M, Arabipoor A, Zolfaghari Z, Taghvaei S. The incidence rate of unresponsive thin endometrium in frozen embryo transfer cycles: A case-series of therapy with granulocyte colony stimulating factor. Int J Reprod Biomed. 2019; 17(12): 923-8. DOI: 10.18502/ijrm.v17i12.5797
15. Bodombossou-Djobo MM, Zheng C, Chen S, Yang D. Neuromuscular electrical stimulation and biofeedback therapy may improve endometrial growth for patients with thin endometrium during frozen-thawed embryo transfer: a preliminary report. Reprod Biol Endocrinol. 2011; 9:122. DOI: 10.1186/1477-7827-9-122
16. Azizi R, Aghebati-Maleki L, Nouri M, Marofi F, Negargar S, Yousefi M. Stem cell therapy in Asherman syndrome and thin endometrium: Stem cell- based therapy. Biomed Pharmacother. 2018; 102: 333-43. DOI: 10.1016/j.biopha.2018.03.091
17. Alsousou J, Thompson M, Hulley P, Noble A, Willett K. The biology of platelet-rich plasma and its application in trauma and orthopaedic surgery: a review of the literature. The Journal of Bone and Joint Surgery. 2009; 91(8): 987-96. DOI: 10.1302/0301-620x.91b8.22546
18. Malahias MA, Chytas D, Babis GC, Nikolaou VS. Platelet-rich plasma guided injections: clinical application in peripheral neuropathies. Front Surg. 2014; 1:41. DOI: 10.3389/fsurg.2014.00041
19. Gato-Calvo L, Magalhaes J, Ruiz-Romero C, Blanco FJ, Burguera EF. Platelet-rich plasma in osteoarthritis treatment: review of current evidence. Ther Adv Chronic Dis. 2019; 10: 2040622319825567. DOI: 10.1177/2040622319825567
20. Samadi P, Sheykhhasan M, Khoshinani HM. The Use of Platelet-Rich Plasma in Aesthetic and Regenerative Medicine: A Comprehensive Review. Aesthetic Plast Surg. 2019; 43(3): 803-14. DOI: 10.1007/s00266-018-1293-9
21. Yuan T, Guo SC, Han P, Zhang CQ, Zeng BF. Applications of leukocyte- and platelet-rich plasma (L-PRP) in trauma surgery. Curr Pharm Biotechnol. 2012; 13(7): 1173-84. DOI: 10.2174/138920112800624445
22. Alio JL, Arnalich-Montiel F, Rodriguez AE. The role of "eye platelet rich plasma" (E-PRP) for wound healing in ophthalmology. Curr Pharm Biotechnol. 2012; 13(7): 1257-65. DOI: 10.2174/138920112800624355
23. Chicharro-Alcantara D, Rubio-Zaragoza M, Damia-Gimenez E, Carrillo-Poveda JM, Cuervo-Serrato B, Pelaez-Gorrea P, et al. Platelet Rich Plasma: New Insights for Cutaneous Wound Healing Management. J Funct Biomater. 2018; 9(1): [aprox. 20 p.]. DOI: 10.3390/jfb9010010
24. Mahajan N, Sharma S. The endometrium in assisted reproductive technology: How thin is thin? J Hum Reprod Sci. 2016; 9(1): 3-8. DOI: 10.4103/0974-1208.178632
25. Zadehmodarres S, Salehpour S, Saharkhiz N, Nazari L. Treatment of thin endometrium with autologous platelet-rich plasma: a pilot study. JBRA Assist Reprod. 2017; 21(1): 54-6. DOI: 10.5935/1518-0557.20170013
26. Eftekhar M, Neghab N, Naghshineh E, Khani P. Can autologous platelet rich plasma expand endometrial thickness and improve pregnancy rate during frozen-thawed embryo transfer cycle? A randomized clinical trial. Taiwan J Obstet Gynecol. 2018; 57(6): 810-3. DOI: 10.1016/j.tjog.2018.10.007
27. Chang Y, Li J, Chen Y, Wei L, Yang X, Shi Y, et al. Autologous platelet-rich plasma promotes endometrial growth and improves pregnancy outcome during in vitro fertilization. Int J Clin Exp Med. 2015; 8(1): 1286-90. [access: 07/05/2021]. Available in: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4358582/pdf/ijcem0008-1286.pdf
28. Kim H, Shin JE, Koo HS, Kwon H, Choi DH, Kim JH. Effect of Autologous Platelet-Rich Plasma Treatment on Refractory Thin Endometrium During the Frozen Embryo Transfer Cycle: A Pilot Study. Front Endocrinol (Lausanne). 2019; 10: 61. DOI: 10.3389/fendo.2019.00061
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Publicado
10.06.2022
Cómo citar
1.
Nguyen Thanh T, Hoang Van A, Trinh The S, Do Ngoc L, Doan Thi H, Quan Van T, et al. Efecto del tratamiento con plasma autólogo rico en plaquetas en pacientes con endometrio delgado. Rev Cubana Med Milit [Internet]. 10 de junio de 2022 [citado 2 de abril de 2025];51(2):e02201802. Disponible en: https://revmedmilitar.sld.cu/index.php/mil/article/view/1802
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