Role of platelet-rich plasma in unexplained recurrent implantation failure: an umbrella review.

Background/objective: The role of platelet-rich plasma (PRP) in assisted reproductive technology is being explored, particularly in cases of recurrent implantation failure (RIF). The objective of our study is to thoroughly synthesise and critically assess the available evidence from systematic reviews and meta-analyses regarding the use of PRP in women with unexplained RIF. Methods: A thorough web search was performed on Medline, PubMed, EMBASE, Web of Science, OVID, JBI Evidence Synthesis, the Cochrane Database of Systematic Reviews, DARE, and the PROSPERO register to identify systematic reviews addressing the research question. Systematic reviews were assessed based on their "explicit, reproducible methodology," comprehensive search strategy, acceptable methods for assessing the validity of included studies, evaluation of the risk of bias, and assessment of the certainty of the evidence. The methodological quality was assessed with the AMSTAR tool comprising 11 items. Before compiling the results, a corrected covered area (CCA) metric was used to evaluate the degree of overlap. Data extraction included descriptive variables and details about the intervention and outcomes. Results: A total of 15 systematic reviews of randomised controlled trials are included. The CCA matrix revealed very high overlap (42%). Although our study showed an improvement in implantation rate, clinical pregnancy rate, and live birth rate, the certainty of evidence was either low or not reported. Therefore, it is difficult to make recommendations based on these findings as the quality of evidence was low. Discussion: Although the qualitative review of these reviews has shown a beneficial effect of PRP in RIF, this result cannot be recommended with certainty, as Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) analysis was performed in only five of the 15 studies. Meta-analysis of the individual outcomes after extracting data from all studies also revealed an overall beneficial effect of PRP in terms of various outcomes, i.e., live birth rate, clinical pregnancy rate, and implantation. However, this may be an overestimation of the true effect due to the low quality of evidence or the quality of evidence not being assessed. Conclusion: Intrauterine infusion of PRP appears to be a promising adjunct therapy for women with unexplained recurrent implantation failure; however, the overall quality of evidence remains low. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024504453, PROSPERO CRD42024504453.