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A Step-By-Step Description of the Hysteroscopic Injection of Platelet-Rich Plasma (PRP) Into the Endo-Myometrial
Danilo Borrelli1, Brunella Zizolfi1, Virginia Foreste1
1Department of Public Health. University of Naples Federico II, Naples, Italy (all authors).
Objective:
to provide a description of the management of a patient with Asherman's syndrome and to present an account of the platelet-rich plasma(PRP) injection procedure at the endometrial-myometrial junction and its effects on endometrial trophism.
Design:
Videoarticle.
Setting:
Tertiary care-center.
Interventions:
A 42-year-old nulliparous(G0P0) woman with Asherman's syndrome [1] following uterine artery embolization for an intramural myoma. The patient reported hypomenorrhea, and transvaginal ultrasound revealed an endometrial thickness of 2.57 mm. A 2D transvaginal ultrasound revealed intrauterine synechiae and a thin endometrium, unresponsive to menstrual cycle variations. Hysteroscopic evaluation [2-3] using a 5 mm continuous-flow hysteroscope in an outpatient setting confirmed extensive intrauterine adhesions with cavity obliteration. Adhesiolysis was performed using 5 Fr scissors, restoring visualization of the tubal ostia [4]. Following adhesiolysis, intrauterine PRP infiltration was performed targeting the endo-myometrial junction on each wall regardless of the sites where adhesiolysis has been carried out [5]. A 17-gauge oocyte-retrieval needle was introduced parallel to the uterine wall to minimize trauma. Full-depth penetration was achieved up to the demarcation zone(excepting the fundus)and 1ml of PRP was delivered per site, with adjustments made as needed to ensure proper infiltration. One week after the procedure, transvaginal ultrasound demonstrated a marked improvement in endometrial thickness compared to baseline. The previously hyperechogenic endometrium showed signs of regeneration and a more trilaminar pattern. Clinically, the patient reported resumption of menstrual flow after one month, indicating a positive endometrial response to the combined adhesiolysis and PRP treatment. No complications or adverse effects were observed. The same procedure was also applied to two additional patients, achieving similar results.
Conclusion:
The combination of hysteroscopic adhesiolysis and intrauterine PRP injection represents a promising approach for managing Asherman's syndrome. PRP may enhance endometrial regeneration, as suggested by both our findings and existing literature. Further studies are needed to assess its impact on reproductive outcomes, including pregnancy and live birth rates. VIDEO ABSTRACT.
