Introduction
infertility
ENDOMETRIUM, CAVITY, PROLIFERATIVE
The uterine factor infertility remains unresolved issue. Under-thickened endometrium (< 7 mm at implantation window) has been associated with reduced implantation rates and poor pregnancy outcomes in the assisted reproductive technology (ART) programs. Thin endometrium indicates the unresponsiveness to growth stimuli (refractory state) and represents an important clinical indicator for cancellations of embryo transfer (ET) cyclesAdministration of autologous platelet-rich plasma (PRP) to the uterine cavity is beneficial for endometrial thickness and has been shown to improve the rates of implantation and clinical pregnancy achieved in ART cycles compared with hormone replacement aloneOther treatment options for refractory thin endometrium involve progenitor/stem cells. In healthy endometrium, cells of the basal layer are enormously proliferative – their self-renewal ensures reconstitution of the functional layer in every menstrual cycleIn this study, we used an alternative protocol for PRP delivery to the site of action. The enhanced efficacy was anticipated on the basis of (1) the larger injection volume (up to 40 mL) and (2) the hysteroscopic image-controlled precision delivery of growth factors to the basal layer of endometrium. This pilot study also evaluates the efficacy of intraendometrial injections for autologous PRP in pure form or mixed with the minimally manipulated endometrial cells (comprising both epithelial and stromal components) as compared with conservative management (physiotherapy) in patients with refractory thin endometrium (Fig. Endometrium parameters. Injection of autologous PRP – the image shows endoscopic needle inserted in the endometrium to the controlled depth of 2–3 mm (