الفهرس 
Endometrial physiology “vascularity, implantation and receptivityOnly 14 pages are availabe for public view
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Abstract
I
nfertility is a global public health issue; about 13% of the couples suffer from infertility. Implantation failure occurs, despite the effort of fertility clinics in the field of ART; therefore, high quality embryo, adequate receptive endometrial, and synchronized development of the embryo and endometrium are critical prerequisite factors for successful implantation. Successful implantation is a critical event for establishment of pregnancy. Defining an optimal endometrium prior to embryo transfer has often been a challenge faced by ART practitioners, and achieving parameters for restoring the damaged endometrium..
A large number of systematic reviews and meta-analyses explained various strategies to improve the EMT, especially in resistant cases.
Zhang et alexplained the predictive value of endometrial characteristics in terms of ART success, such as Echo pattern and EMT.
Thin endometrium is still a challenge in ART, which usually results in cycle cancellation, slightly enhanced with these comprising hormonal management by prolonged use of E2 and hCG, vasoactive agents such as aspirin and nitroglycerin, intrauterine infusion of growth factor such as G-CSF.
However, a number of women with thin endometrium remain non-responsive even these remedies have been performed. Thus, there is a need for an alternative treatment for patients with refractory thin endometrium.
Zadehmodarres et al stated that, the Endometrium is one of the main factors in pregnancy. During ART treatments, some cycles are cancelled due to inadequate endometrial growth, with recommendation that optimal EMT is one of critical factors for successful embryo implantation. Consequently, endometrium preparation has been considered a crucial step for ET.
Kim et al reported that usage of intrauterine autologous PRP improved the implantation, pregnancy, and live birth rates (LBR) of the patients with refractory thin endometrium.
This study lays the foundations for the potential treatment of thin endometrium with poor response to conven¬tional therapy with intrauterine autologous PRP representing its role on EMT &receptivity, successful embryo implantation and ongoing pregnancy rate in patients undergoing IVF.
This prospective single arm clinical trial was conducted at ART Unit of Ain Shams University Maternity Hospital to evaluate the effect of autologous PRP in improving the ongoing pregnancy rate in patients with refractory thin endometrium undergoing IVF. This study was applied on eighty five infertile women with a refractory thin endometrium, 6 cases were excluded and 13 cases are cancelled with the same inclusion and exclusion criteria using long luteal phase GnRH protocol.
Regarding effect of baseline characteristics and hormonal profile on chemical pregnancy; statistical analysis of current results showed that there was no statistically significant difference between chemical pregnancy (positive and negative) according to baseline characteristics (age, BMI, duration of infertility, number of prior ART cycles and type of infertility) with (p>0.05 NS) and hormonal profile (FSH, LH, E2, AMH, Prolactin, TSH, E2 and P4 on hCG triggering day) with p-value >0.05.
Regarding EMT comparison and endometrial pattern distribution with D 1 (day of hCG&PRP infusion) vs. D 2 (day of OR) and D 3 (day of ET); statistical analysis of current results showed that there was statistically significant increase of EMT “mm” and pattern after intrauterine PRP infusion.
Regarding risk factors affecting chemical pregnancy; multivariate analysis of current study revealed that EMT (mm) and endometrial pattern at D2 and D3 were the best independent predictors of chemical pregnancy.
Regarding outcomes of embryo transferred cycles; statistical analysis of current results showed that there were high positive pregnancy results (implantation, chemical, clinical and ongoing pregnancy and miscarriage rates) as a result of intrauterine PRP infusion.
Current study agreed with the following studies; Nazari,Kim,Tandulwadkar, Kusumi, Maleki-Hajiagha, Eftekhar, Chang, Zadehmodarres and Molina and their colleagues. As regard the role of intrauterine infusion of autologous PRP in improving the EMT,vascularity and receptivity in women with suboptimal endometrium, enhancing the pregnancy outcomes and reducing the incidence of ET cycle cancellation.
On the other hand, current study disagreed with Tehraninejad and his colleague. As regard that intrauterine infusion of autologous PRP is not an effective adjuvant treatment for IVF of patients with RIF and normal EMT undergoing ET. that might be due to the normal EMT of recruited women.
• Strengths of current study were due to it was prospective single arm clinical trial with minimal percent of bias. Every effort was made to ascertain that all follow-up data were correct, and only complete information was included in data analysis. All clinical assessment ovulation induction and assessment of study outcomes were done by the same team. Being an autologous resource, therefore harmless to the patient, easy to obtain, of very low cost and contains a high concentration of growth factors (growth factors were obtained by genetic and recombi¬nant engineering procedures; being expensive and repeated doses were required to achieve an optimal therapeutic effect). We defined the platelet concentration and type of PRP that we used.
• Limitations of current study were due to COVID 19 pandemic, and relatively small sample size, exclusion and cancellations of many cases. It was done on fresh cycle only, using luteal phase Gonadotrophins releasing hormone agonist (GnRHa) protocol.
And the unknown genetic composition of embryos that were used in our study (as we were usually not doing pre- implantation genetic testing (PGT) as a routine), despite using a morphological good-quality blastocysts. Embryo morphology might not really represent the real quality of embryos.