A Randomised Controlled Trial Investigating Intrauterine Platelet-Rich Plasma in Women with Repeated Implantation Failure

Platelet Rich Plasma (PRP) is an autologous blood product enriched with growth factors and cytokines. PRP is created from a small blood sample obtained from the participant and processed through centrifugation to separate and concentrate platelets. It is currently thought of as experimental but due to positive results in some studies it is used in clinical practice by some private clinicians at a cost to the patient in a variety of clinical scenarios including recurrent implantation failure, thin or scarred endometrium or injected into the ovary to help with response to hormonal stimulation in assisted reproductive technology. There is a long history of its use in other specialties for example musculoskeletal medicine and dermatology. PRP production involves no external devices or medications requiring regulatory approval. PRP can be created through the help of a commercially available kit. There is no evidence suggesting harm associated with PRP use. The treatment group will receive a single intrauterine infusion of PRP 2-3 days prior to embryo transfer. participants randomised to the intervention arm will undergo: • Blood collection of 8.5 mL, mixed with 1.5 mL of anticoagulant (acid citrate), 2–3 days prior to embryo transfer. • The sample is processed on-site using a two-step centrifugation protocol to isolate approximately 0.75 mL of PRP. Before administration, PRP is activated by mixing with 0.25 mL of non-coagulated whole blood. • A single intrauterine infusion of PRP will be performed using a soft embryo transfer catheter (e.g., GuardiaTM Access, Cook Medical), inserted through the cervix and up to the internal os. The PRP is infused gently into the endometrial cavity. • The procedure will be conducted by a fertility specialist or gynaecologist, in accordance with site-specific protocols. Participants in the placebo arm will undergo an identical procedure including blood draw and catheter insertion, but without PRP infusion. Adherence to the intervention protocol will be monitored through audit of clinic medical records, review of procedure documentation, and case report forms (CRFs). Each site will be required to document the completion of blood collection, PRP preparation, and the intrauterine infusion procedure, including timing relative to embryo transfer. Study-specific procedure logs and REDCap data entries will be used to confirm protocol compliance across both intervention and placebo arms.