Hormone therapy with or without platelet-rich plasma (PRP) for treatment Asherman syndrome; A randomized clinical trial


Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran


Background: Asherman syndrome is a controversial issue in obstetrics and gynecology without any consensus on its management and treatment. It is characterized by variable lesions inside the uterine cavity and also causes menstrual irregularities, infertility, and placental abnormalities. The study aimed to assess the platelet-rich plasma (PRP) effect in women with intrauterine adhesions by evaluating the improvement of the menstrual cycle and intrauterine adhesion (IUA) stage.
Materials and Methods: This clinical trial study was performed on 60 women with Asherman syndrome in two groups of 30. For the first group, only hormone therapy was performed and for the second group, hormone therapy with platelet-rich plasma after hysteroscopy. Recovery of Asherman syndrome and IUA stage was assessed at 6 to 8 weeks after hysteroscopy and compared between the two groups.
Results: Our results demonstrated that there was no significant difference between demographic data in the two groups as well as the menstrual pattern of both groups before or after treatment (P > 0.05). Frequency distribution of IUA after the intervention in the PRP + hormone therapy group in grade I, II, and III were equal to 73.3%, 20%, and 6.7% and in the hormone therapy group were 53.3%, 26.7%, and 20%, respectively (P = 0.22). In addition, hypo menorrhea was observed in 33.3% of PRP + hormone therapy group and 40% of the hormone therapy group with no significant difference between the two groups (P = 0.71).
Conclusion: Hormone therapy with PRP compared to hormone therapy alone after routine surgical treatment had not a significant effect on the IUA stage, duration, and severity of menstruation.


Di Guardo F, Della Corte L, Vilos GA, Carugno J, Török P, Giampaolino P, et al. Evaluation and treatment of infertile women with Asherman syndrome: An updated review focusing on the role of hysteroscopy. Reprod Biomed Online 2020;41:55-61.  Back to cited text no. 1
Queckbörner S, Davies LC, von Grothusen C, Santamaria X, Simón C, Gemzell-Danielsson K. Cellular therapies for the endometrium: An update. Acta Obstet Gynecol Scand 2019;98:672-7.  Back to cited text no. 2
Ludwin A, Martins WP, Ludwin I. Ultrasound-guided repeat intrauterine balloon dilatation for prevention of adhesions. Ultrasound Obstet Gynecol 2019;54:566-8.  Back to cited text no. 3
Chikazawa K, Imai K, Liangcheng W, Sasaki S, Horiuchi I, Kuwata T, et al. Detection of Asherman's syndrome after conservative management of placenta accreta: A case report. J Med Case Rep 2018;12:344.  Back to cited text no. 4
Tarney CM, Han J. Postcoital bleeding: A review on etiology, diagnosis, and management. Obstet Gynecol Int 2014;2014:192087.  Back to cited text no. 5
Shapley M, Blagojevic-Bucknall M, Jordan K, Croft P. The epidemiology of self-reported intermenstrual and postcoital bleeding in the perimenopausal years. Br J Obstet Gynaecol 2013;120:1348–55.  Back to cited text no. 6
Dreisler E, Kjer JJ. Asherman's syndrome: Current perspectives on diagnosis and management. Int J Womens Health 2019;11:191-8.  Back to cited text no. 7
Zackler A, Flood P, Dajao R, Maramara L, Goetzl L. Suspected chorioamnionitis and myometrial contractility: Mechanisms for increased risk of cesarean delivery and postpartum hemorrhage. Reprod Sci 2019;26:178-83.  Back to cited text no. 8
Pansky M, Feingold M, Sagi R, Herman A, Schneider D, Halperin R. Diagnostic hysteroscopy as a primary tool in a basic infertility workup. JSLS 2006;10:231-5.  Back to cited text no. 9
Ajayi A, Biobaku O, Ajayi V, Oyetunji I, Aikhuele H, Afolabi BM. Detection of intrauterine lesions by hysteroscopy among women with fertility challenges in an in-vitro fertilization center in Lagos, Nigeria. Crit Care Obst & Gyne 2015;1:1.  Back to cited text no. 10
Letterie GS, Haggerty MF. Magnetic resonance imaging of intrauterine synechiae. Gynecol Obstet Invest 1994;37:66–8.  Back to cited text no. 11
Bacelar AC, Wilcock D, Powell M, Worthington BS. The value of MRI in the assessment of traumatic intra-uterine adhesions (Asherman's syndrome) Clin Radiol 1995;50:80–3.  Back to cited text no. 12
Alves R, Grimalt R. A review of platelet-rich plasma: History, biology, mechanism of action, and classification. Skin Appendage Disord 2018;4:18-24.  Back to cited text no. 13
Chicharro-Alcántara D, Rubio-Zaragoza M, Damiá-Giménez E, Carrillo-Poveda JM, Cuervo-Serrato B, Peláez-Gorrea P, et al. Platelet rich plasma: New insights for cutaneous wound healing management. J Funct Biomater 2018;9:10.  Back to cited text no. 14
Nazari L, Salehpour S, Hoseini S, Zadehmodarres S, Ajori L. Effects of autologous platelet-rich plasma on implantation and pregnancy in repeated implantation failure: A pilot study. Int J Reprod Biomed (Yazd) 2016;14:625-8.  Back to cited text no. 15
Sommeling CE, Heyneman A, Hoeksema H, Verbelen J, Stillaert FB, Monstrey S. The use of platelet-rich plasma in plastic surgery: A systematic review. J Plast Reconstr Aesthet Surg 2013;66:301–11.  Back to cited text no. 16
Jang HY, Myoung SM, Choe JM, Kim T, Cheon YP, Kim YM, et al. Effects of autologous platelet-rich plasma on regeneration of damaged endometrium in female rats. Yonsei Med J 2017;58:1195-203.  Back to cited text no. 17
AAGL Elevating Gynecologic Surgery. AAGL practice report: Practice guidelines on intrauterine adhesions developed in collaboration with the European Society of Gynaecological Endoscopy (ESGE). Gynecol Surg 2017;14:6.  Back to cited text no. 18
Sugimoto O. Diagnostic and therapeutic hysteroscopy for traumatic intrauterine adhesions. Am J Obstet Gynecol 1978;11:539–47.  Back to cited text no. 19
Yu D, Wong YM, Cheong Y, Xia E, Li TC. Asherman syndrome-one century later. Fertil Steril 2008;11:759–79.  Back to cited text no. 20
Zhang S, Li P, Yuan Z, Tan J. Platelet-rich plasma improves therapeutic effects of menstrual blood-derived stromal cells in rat model of intrauterine adhesion. Stem Cell Res Ther 2019:10:61.  Back to cited text no. 21
Kim JH, Park M, Paek JY, Lee WS, Song H, Lyu SW. Intrauterine infusion of human platelet-rich plasma improves endometrial regeneration and pregnancy outcomes in a murine model of Asherman's syndrome. Front Physiol 2020;11:105.  Back to cited text no. 22
Aghajanova L, Cedars MI, Huddleston HG. Platelet-rich plasma in the management of Asherman syndrome: Case report. J Assist Reprod Genet 2018;35:771–5.  Back to cited text no. 23
Eftekhar M, Neghab N, Naghshineh E, Khani P. Can autologous platelet rich plasma expand endometrial thickness and improve pregnancy rate during frozen-thawed embryo transfer cycle? A randomized clinical trial. Taiwan J Obstet Gynecol 2018;57:810-3.  Back to cited text no. 24
Javaheri A, Kianfar K, Pourmasumi S, Eftekhar M. Platelet-rich plasma in the management of Asherman's syndrome: An RCT. Int J Reprod Biomed (Yazd) 2020;18:113-20.  Back to cited text no. 25
Amer MI, El-Sayed Ahmed M, Mokhtar Kamal R, Abd Elwahab Torky AM. The value of using platelet rich plasma after hysteroscopic analysis of severe intrauterine adhesions (a randomized controlled trial). Egypt J Hosp Med 2018;71:2869-74.  Back to cited text no. 26