Comparing intra-uterine injection of mononuclear cells and platelet-rich plasma on the pregnancy rate of women with recurrent implantation failure: An RCT

Background: Recurrent implantation failure (RIF) can be explained mainly by improper crosstalk between the embryo and endometrium. The T-helper1/T-helper2 profile balance influences effective embryo implantation. Endometrial immunomodulation via intrauterine injection of activated peripheral blood mononuclear cells (PBMCs) or autologous platelet-rich plasma (PRP) is a potentially efficient treatment option. Objective: This study aims to examine the biochemical and clinical pregnancies resulting from the intrauterine administering of activated PBMCs and PRP in RIF women. Materials and Methods: This randomized clinical trial study was done in the Rooya Infertility Treatment Center, Qom, Iran from November 2022 to April 2024. 96 women with at least 2 RIFs were randomized into control, PBMC, and PRP groups. Briefly, 3 ml of blood sample was collected and PBMCs were isolated using Ficoll separation solution, and cultured for 72 hr. PRP was separated from 10 ml of peripheral blood through centrifugation. 2 days before embryo transfer PBMCs or PRP were transferred into the endometrial cavity. Results: Except for the duration of infertility, which was higher in the PBMC group, all other baseline characteristics were not statistically different. Moreover, a significantly higher rate of biochemical pregnancy was observed in the PRP (10/32) and PBMC (12/32) groups compared to the control (3/32) (p = 0.027), while the rate of clinical pregnancy was only significantly higher in the PBMC group (10/32) than in the control group (2/32) (p = 0.038). Conclusion: Neither PBMC nor PRP interventions exhibited a substantial advantage over one another regarding biochemical and clinical pregnancy rates.