Abstract
To evaluate the effectiveness of subendometrial autologous platelet-rich plasma (PRP) injections in improving endometrial thickness (EMT) and pregnancy outcomes in women with refractory thin endometrium. This prospective, single-arm, self-controlled trial was conducted at Nanjing Drum Tower Hospital between October 2023 and October 2024. A total of 21 women with refractory thin endometrium (EMT < 7 mm), including those with a history of multiple failed treatments (e.g., high-dose oestrogen, surgical adhesiolysis), were treated with subendometrial PRP injections. EMT and reproductive outcomes were assessed before and after PRP treatment. Subendometrial blood flow, intrauterine adhesion (IUA) status, and platelet count (PLT) were also evaluated. Data from pre- and posttreatment cycles were analysed using paired t-tests for continuous variables and Fisher’s exact tests for categorical variables. Among the 21 enrolled patients, 18 completed the study. With respect to the baseline characteristics, the mean age of the patients was 36.7 years and the mean duration of infertility was 3.0 years (IQR 2.0–5.25). PRP treatment resulted in a significant increase in EMT from 6.55 mm (IQR 6.08–7.03) to 7.50 mm (IQR 6.78–8.10) (p < 0.001). In 12 patients (66.7%), the EMT reached ≥ 7 mm posttreatment. Despite these improvements, significant enhancement in EMT was not observed in 2 patients with severe adhesions. The clinical pregnancy rate (CPR) in frozen-thawed embryo transfer (FET) cycles was 44.4%, with 8 pregnancies (2 live births, 6 ongoing). A decrease in cancellation rates posttreatment (2.62 vs. 0.71, p = 0.016) was observed. The procedure was safe and well tolerated, with no serious adverse events reported. The PLT in PRP was 3.69 times higher than that in whole blood (p < 0.001), but there was no significant difference in serum oestradiol levels before and after PRP. Subendometrial PRP injections improved EMT and achieved a clinical pregnancy rate of 44.4% in this cohort. This approach may represent a promising alternative for patients with refractory thin endometrium unresponsive to conventional therapies, potentially enhancing fertility outcomes in ART cycles. As a small pilot study, these results are preliminary and should be interpreted with caution.
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The data that support the findings of this study are available from the corresponding author upon reasonable request.
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Acknowledgements
HZ and HW contributed equally to this work. HZ was responsible for the statistical analysis of raw data and drafted the manuscript. HW performed the platelet-rich plasma (PRP) injections under hysteroscopic guidance. JY was responsible for PRP preparation, including its storage, transportation, and quality control. CH contributed to statistical validation and data interpretation. YJ oversaw the study design, patient management, and overall clinical coordination. The authors sincerely thank all clinical and laboratory personnel for their valuable support during the study. This research was funded by the National Natural Science Foundation of China, the Fertility Research Program for Young and Middle-Aged Physicians – Clinical Research (2022 and 2023), and the Clinical Trials Funding Program of the Affiliated Drum Tower Hospital, Medical School of Nanjing University.
Funding
This work was supported by Project of national natural science foundation of China (82301901), Fertility Research Program of Young and Middle-aged Physicians-Clinical Research In 2022 and 2023 (Beijing Health Promotion Association, BJHPA-2022-SHZHYXZHQNYJ-LCH-002, BJHPA-2023-SZHYXZHQN-006), fundings for Clinical Trials from the Affiliated Drum Tower Hospital, Medical School of Nanjing University (2021-LCYJ-MS-20). There are no conflicts of interest.
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This prospective single–arm, self–controlled trial was conducted at the IVF Center of Nanjing Drum Tower Hospital, affiliated with the Medical School of Nanjing University, from October 2023 to October 2024. The study received ethical approval from the hospital’s Ethics Committee (reference number 2023–625–02).
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Zhang, H., Wang, H., Yu, J. et al. Subendometrial platelet-rich plasma injection for refractory thin endometrium: a prospective pilot study. Sci Rep (2026). https://doi.org/10.1038/s41598-026-38286-0
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DOI: https://doi.org/10.1038/s41598-026-38286-0
