The role of platelet-rich plasma in repeated implantation failure: a review of biological mechanisms and clinical efficacy

Repeated implantation failure (RIF) remains a significant challenge in assisted reproductive technology, with approximately two-thirds of cases attributed to impaired endometrial receptivity. This review highlights the role of autologous platelet-rich plasma (PRP) as a regenerative adjuvant for rehabilitating the uterine environment. Molecular mechanisms and clinical evidence are presented. It is evident that the concentrated growth factors in PRP—such as VEGF, PDGF, and TGF-beta—promote cell proliferation, angiogenesis, immunomodulation and tissue remodeling. Α consistent statistical trend is recognized toward improved clinical pregnancy and live birth rates across multiple meta-analyses. However, a critical methodological-clinical gap is identified, noting that the current evidence base is compromised by a high risk of bias, non-standardized preparation protocols, and inconsistent diagnostic criteria for RIF. While PRP shows significant biological promise in transforming a hostile uterine environment into a receptive one, its routine clinical application is currently cautioned. Until large-scale, properly blinded randomized controlled trials -utilizing standardized ESHRE definitions- are conducted, PRP should be regarded as an experimental tool rather than a validated standard of care.