Observational studyFrontiers in endocrinology2026
Beyond endometrial thickness: platelet-rich plasma and reproductive outcomes in recurrent implantation failure following euploid embryo transfer.
Observational study in Frontiers in endocrinology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Recurrent implantation failure (RIF) after euploid embryo transfer suggests that endometrial receptivity, rather than embryo competence alone, may be rate-limiting for pregnancy. Autologous platelet-rich plasma (PRP) has been proposed as a biological adjuvant for reproductive outcomes, but evidence in women with normal endometrial thickness remains limited. We investigated whether intrauterine PRP is associated with higher implantation rates in women with RIF and normal endometrial thickness undergoing single euploid blastocyst transfer. Methods: Prospective observational cohort study of 230 women with recurrent implantation failure (110 platelet-rich plasma; 120 controls) conducted at a single tertiary center; enrolment and transfer took place between December 2023 and December 2024, with follow-up for reproductive outcomes extending through December 2025.Women aged 18-45 years with endometrial thickness >7 mm undergoing single euploid blastocyst transfer were included. Platelet-rich plasma was administered intrauterinely as a single infusion 36-72 hours before transfer. Risk ratios and absolute risk differences were estimated, with adjustment for measured confounders using propensity-score overlap-weighted modified Poisson regression. The propensity-score analysis was restricted to 228 complete cases because infertility duration was missing for two patients in the PRP group. Results: Clinical pregnancy (equivalent to implantation rate in this single-embryo-transfer design) was higher in the platelet-rich plasma group than in controls (71.8% vs 40.8%; crude risk ratio 1.76, 95% confidence interval 1.38-2.25; P<0.001). Positive β-hCG, ongoing pregnancy and live birth rates were also higher. After adjustment for confounders using propensity-score overlap weighting, platelet-rich plasma remained associated with clinical pregnancy (adjusted risk ratio 1.86, 95% confidence interval 1.44-2.39; P<0.001) and with the other three principal outcomes. Conclusion: Intrauterine platelet-rich plasma was associated with higher rates of implantation and pregnancy in women with recurrent implantation failure undergoing euploid embryo transfer despite normal endometrial thickness. Because allocation was based on the patient's own decision rather than randomization, these findings cannot establish causality and warrant confirmation in randomized controlled trials.
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