The impact of platelet-rich plasma infusion in infertile women undergoing assisted reproduction: a systematic umbrella review of the best clinical evidence

INTRODUCTION: To date, the application of platelet-rich plasma (PRP) to women in assisted reproductive technologies is a potential therapeutic method that has been developed. This umbrella review is designed to summarize the best evidence regarding the treatment potential of PRP in infertile patients. EVIDENCE ACQUISITION: A systematic literature search was conducted on the main database (PubMed, the Cochrane Library and Web of Science) for systematic reviews and meta-analyses describing the effect of PRP on fertility outcomes. The retrieved data was extracted, and the quality of the included studies was assessed using the Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR-2) tool. EVIDENCE SYNTHESIS: Seven systematic reviews were finally included. The quality of evidence was high in one review, moderate to low in five, and low in one. In terms of ovarian PRP, antral follicular count (AFC) and the number of retrieved oocytes were shown to have significant differences. Nonetheless, the livebirth rates did not demonstrate a clinically relevant improvement. Concerning endometrial PRP, an improvement in the clinical pregnancy rate both in cases of repeated implantation failure and thin endometrium was suggested; nonetheless, no effect on live birth rates and miscarriage rates was detected. Results of laboratory tests showed transient rises of AMH and fall in FSH with ovarian PRP, but this effect was not consistent over time. CONCLUSIONS: This umbrella review showed that PRP infusion was a potential technique for improving particular reproductive outcomes according to the available literature, particularly on premature ovarian insufficiency, poor ovarian response and recurrent implantation failure patients. However, the overall quality of the studies is low, and future studies should concentrate on more robust methodologies and higher standards of evidence and on the standardization of PRP protocols and the evaluation of both short- and long-term results to establish more clear recommendations for its use in assisted reproductive technologies.