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PRP for Thin Endometrium: Evidence, Routes, and Clinical Protocol

The Short Answer

PRP for thin endometrium is promising, not proven. Made from your own blood, PRP roughly doubled pregnancy rates in small randomized trials of women whose lining stayed thin¹, but reviews rate the certainty of the evidence from very low to moderate²,³. At ESSI we inject it beneath the lining under direct view, after other causes are treated.

  • Fix the basics first: the estrogen dose and route, scarring, infection, and the other causes of failed transfers.

  • Ask where the PRP goes. Washed into the cavity, or placed beneath the lining, where the lining regrows?

  • Thicker is not the same as pregnant. Thickness is a marker, not the goal.

  • Expect honest odds. The studies are small, and no treatment can promise a baby.

You have done everything asked of you. The estrogen is going in, the embryos are waiting, and the scan shows the same thing again: the lining hasn’t grown. The transfer is cancelled, or it goes ahead on a lining everyone is worried about.

This page explains what a thin lining means, what to check before anything else, what PRP is, and what the evidence does and does not show. Start with the short video.

Watch: Hysteroscopic PRP at ESSI

In under two minutes, Dr. Vidali explains why the lining itself can be the problem, what the trials show, and how we use PRP at ESSI.

Read the Video Transcript

Failed transfers, a lining that won’t grow, scarring, or repeated losses? Sometimes the problem is the lining itself. PRP, made from your own blood, may help it rebuild.

Usually, PRP is washed into the uterus, and much of it flows out. But the cells that rebuild the lining live deeper, in the basal layer. So at ESSI, we inject it right there, under direct view with a hysteroscope.

The science is not definitive yet, but the signs are encouraging. In 8 randomized trials of women with a thin lining, PRP doubled the pregnancy rate, and more than doubled live births. And when the lining itself was the problem, injecting PRP beneath it gave about twice the odds of pregnancy, compared with washing it in. After scar tissue is removed, adding PRP cut the return of significant scarring by about half.

These studies are small and mixed in quality, and no treatment can promise a baby. But I believe it is worth offering.

We consider it for repeated implantation failure, a thin lining that won’t grow, Asherman syndrome after scar removal, and recurrent pregnancy loss, when we believe the lining is part of the problem. First, we treat other causes, like endometritis, adenomyosis and endometriosis. Then we place PRP from your own blood beneath the lining, before you try again.

(The studies quoted in the video are Liu 2024, Kumar 2025 and Wang 2025, listed in the references below.)

What Counts as a Thin Endometrium?

The endometrium is the lining of your uterus, where an embryo implants. Before an embryo transfer, a lining under 7 mm on ultrasound is usually called thin⁴.

It is uncommon. In a review of 22 studies of IVF, a lining of 7 mm or less was seen in 2.4% of reported cases (260 of 10,724), and clinical pregnancy was less likely with it: 23.3%, against 48.1% with a thicker lining⁵.

But thickness is a blunt measure. The same review found that thickness on its own was poor at predicting who would conceive⁵. And the ESHRE working group on implantation failure cites a large study concluding that when a genetically tested (euploid) frozen blastocyst is transferred, lining thickness “does not seem to predict the chance of implantation”⁶. A thin lining is a warning sign, not a verdict.

Why Does a Lining Stay Thin?

Your lining regrows every month from its deepest layer, the basal layer, which holds the stem and progenitor cells that rebuild it⁷. When that layer is damaged, or doesn’t respond, the lining stays thin. There are two broad stories:

  • Scarring: Trauma to the inside of a pregnant or recently pregnant uterus, such as a D&C after a miscarriage or a delivery, can leave adhesions inside the uterus: Asherman syndrome. Periods often become much lighter, or stop⁸.

  • A lining that doesn’t respond: Some linings stay thin even with estrogen and drugs that improve blood flow⁹.

What Should Be Checked Before PRP?

PRP is not the first step. Before we treat the lining itself, we make sure the basics are right:

  1. Estrogen: In the words of the ESHRE working group, “ensuring sufficient exposure to estradiol by augmenting oral therapy with patches or vaginal treatment remains the mainstay of management”⁶.

  2. The cavity: Hysteroscopy, a thin camera passed through the cervix, is the standard way to find scarring inside the uterus, and to remove it⁸.

  3. Chronic endometritis: When it fits your history, we test for this low-grade inflammation of the lining with a biopsy stained for CD138, and treat it when it is found. Our post on endometritis and endometriosis explains it.

  4. The rest of the picture: We also look for adenomyosis and endometriosis, and treat them first when they are present.

Other treatments have been tried for linings that won’t respond. In 2011, Dr. Vidali co-authored a report of four women whose resistant lining reached at least 7 mm after G-CSF, a growth factor, was infused into the uterus⁹. That was four patients. The one trial that compared PRP with G-CSF for live birth was too small and uncertain to show a difference².

What Is PRP, and How Could It Help a Thin Lining?

PRP stands for platelet-rich plasma. A sample of your own blood is spun to concentrate its platelets in a small volume of plasma. Platelets carry growth factors and signalling proteins, which “are considered to exert a regenerative effect on tissues and cells, including the endometrial lining,” in the ESHRE working group’s words⁶.

Two cautions:

  • PRP is not one product: Platelet concentration and preparation vary widely between studies, and many studies report them poorly⁶.

  • Tissue targeting: Because the lining regrows from the basal layer⁷, where the PRP ends up may matter as much as the PRP itself.

Does PRP Work for a Thin Endometrium?

Most randomized trials so far have tested PRP washed into the cavity through a thin catheter, a method called infusion. A 2024 meta-analysis pooled 8 of them, in 678 women with a thin lining¹.

With PRP, the lining was 1.23 mm thicker on average, clinical pregnancy was about twice as likely (risk ratio 2.04), live birth about two and a half times as likely (risk ratio 2.46), and cycles were cancelled about half as often (risk ratio 0.46)¹.

A 2026 umbrella review of 21 systematic reviews reached a similar conclusion for thin linings and intrauterine adhesions: better pregnancy outcomes and fewer cancelled cycles, with miscarriage rates largely unchanged. Across all the uses it reviewed, it rated the certainty of the evidence from very low to moderate³.

That is the encouraging side, and it is real. The cautious side is further down this page.

Does It Matter Where the PRP Goes?

Infused PRP lands on the surface of the lining. The cells that rebuild the lining sit deeper, in the basal layer⁷. Injection places PRP beneath the lining, at the junction between the lining and the uterine muscle, with a fine needle guided by ultrasound or seen directly through a hysteroscope⁴,¹⁰. The idea follows the biology: the lining regenerates from that junction¹⁰.

  1. What the Comparisons Show

    • When the lining is the problem, injection looks better: A 2025 review of 7 non-randomized studies found higher clinical pregnancy rates with injection than with infusion (odds ratio 1.59, in the 5 studies and 554 women that compared the two routes), and the difference was largest when the lining itself was the problem (odds ratio 2.07)⁴.

    • Thicker is not the same as pregnant: In 116 women with a persistently thin lining who had genetically tested embryos transferred, infusion brought more linings above 7 mm than injection did (78.2% against 55.3%), yet injection appeared to help more: live birth was 38%, against 4% in women who had no PRP¹¹.

    • After adhesion surgery, injection did better too: In 299 women treated for moderate-to-severe adhesions, the matched comparison gave a clinical pregnancy rate of 29.4% after injection, against 16.2% after infusion¹².

    • The largest injection cohort: In 200 women with an unresponsive thin lining, live birth was 17.5% with injection and 2.0% without it, but the women chose whether to have PRP, which biases the comparison¹³.

    • When the lining is not the problem, the route may not matter: In women with repeated implantation failure, injection and infusion did equally well (ongoing pregnancy or live birth in 40% and 41.3%, against 22.1% without PRP)¹⁴, and the 2025 review found no advantage for injection in that group (odds ratio 0.95)⁴.

    None of these comparisons is randomized, and no randomized trial has compared injection with infusion⁴. Randomized evidence on injection is limited to small pilot studies. In one, of 115 women with a thin lining, injection thickened the lining, and live birth was 21.4% and 23.7% in the two injection groups against 13.3% with standard treatment, a difference that was not statistically significant¹⁵.

    Can PRP Help After Asherman Surgery?

    Scarring inside the uterus is removed first, with hysteroscopic surgery⁸. The question is whether PRP keeps it from coming back.

    A 2025 review of 12 studies (874 women, 8 of the studies randomized) found that with PRP after adhesion surgery, moderate-to-severe adhesions came back about half as often (risk ratio 0.48) and clinical pregnancy was more likely (risk ratio 1.37), but live birth was not significantly different¹⁶.

    Severe scarring is the hardest case. In a 2026 pilot study of injection for a refractory thin lining, 12 of the 18 women who completed it reached 7 mm or more, but two women with severe adhesions, each after three or more adhesion surgeries, did not improve: their lining got thinner. Most women in that pilot also had PRP infused during the transfer cycle, so the effect of injection alone can’t be separated¹⁷.

    What the Evidence Does Not Show

    You should decide with the full picture, so here is the other side:

    • The overall certainty is low: Cochrane’s 2024 review (12 randomized trials, 1,069 women) rated the evidence very low certainty for almost all outcomes. Only one trial was at low risk of bias, and in it live birth was not clearly different (odds ratio 1.10, 95% CI 0.38 to 3.14; 94 women)².

    • A possible preterm-birth signal: One trial found more preterm births after PRP infusion (odds ratio 8.02; 120 women), rated low certainty², and a 2026 review of trials in repeated implantation failure found the same direction (odds ratio 8.24), with its authors calling for investigation¹⁸. It is not settled, and data on pregnancies beyond live birth are limited⁴.

    • Injection has barely been tested in randomized trials: No trial has compared it with infusion⁴, and a pilot comparing it with standard treatment did not show a statistically significant difference in live birth¹⁵.

    • Guidelines are cautious: For repeated implantation failure, ESHRE’s 2023 good practice recommendations state: “Intrauterine platelet-rich plasma (PRP) infusion is not recommended”⁶. Since then, two 2026 meta-analyses of randomized trials in repeated implantation failure have reported higher pregnancy and live birth rates with infusion, but they pool small trials¹⁸,¹⁹, and a published letter has questioned how one of them reported its statistics²⁰.

    • Recurrent pregnancy loss has almost no direct evidence: One small randomized trial (40 women completed it) found live births in 15% with PRP infusion and in none without, a difference that was not statistically significant²¹. A 2026 review judged the direct evidence insufficient to show fewer miscarriages or more live births²².

    • Severe scarring may respond least⁸,¹⁷.

    Who May Benefit? Dr. Vidali’s View

    ESSI follows the evidence where it is clear, and says so when a decision rests on clinical judgment. Dr. Vidali says it plainly in the video: “These studies are small and mixed in quality, and no treatment can promise a baby. But I believe it is worth offering.”

    We consider PRP for:

    • A thin lining that won’t grow, despite adjusted estrogen: This is where the evidence is strongest¹,⁴.

    • Asherman syndrome, after the scarring is removed: PRP lowered the return of scarring; a live-birth benefit has not been shown¹⁶.

    • Repeated implantation failure: Most PRP trials were done in this group, with mixed results²,¹⁹. Injection offers no clear advantage over infusion here unless the lining is also a problem⁴.

    • Recurrent pregnancy loss, when we believe the lining is part of the problem: The direct evidence here is very limited²², and the decision rests on Dr. Vidali’s clinical judgment.

    Questions to Ask Your Doctor

    • How thick was my lining, on which day, and on what dose and route of estrogen?

    • Has the inside of my uterus been checked with hysteroscopy? Is there scarring?

    • Have I been tested for chronic endometritis?

    • Could adenomyosis or endometriosis be part of the problem?

    • If you offer PRP, will it be infused into the cavity or injected beneath the lining?

    • How is the PRP prepared, and how many treatments do you plan?

    • When is it done in relation to my transfer?

    How ESSI Approaches a Thin Lining and PRP

    Hysteroscopic PRP is now offered at ESSI. We see it as one step in a plan, not a stand-alone fix, and we offer it with the evidence on the table. Dr. Vidali has worked on linings that won’t respond since at least 2011, when he co-authored an early report on uterine G-CSF⁹.

    • Other causes first: We look for and treat chronic endometritis, adenomyosis and endometriosis before we treat the lining.

    • PRP from your own blood: It is made from a sample of your blood, so there is no donor material.

    • Placed beneath the lining, under direct view: Through a hysteroscope, we inject PRP into the basal layer rather than washing it into the cavity.

    • Before you try again: PRP is placed before your next transfer, as part of one plan with your fertility team.

    Frequently Asked Questions

    Does PRP work for a thin endometrium?

    It may help, but it isn’t proven. In 8 randomized trials of women with a thin lining, PRP infusion roughly doubled clinical pregnancy and more than doubled live birth rates¹. Cochrane rates the overall evidence as very low certainty, and its one low-risk trial showed no clear difference in live birth². Treat it as a promising option, not a sure one.

    Is PRP injection better than infusion?

    Probably, when the lining itself is the problem. A 2025 review of 7 non-randomized studies found about twice the odds of clinical pregnancy with injection in women with a thin or poorly responding lining, but no advantage in repeated implantation failure alone⁴. No randomized trial has compared the two routes yet.

    Is PRP in the uterus safe?

    PRP comes from your own blood, and a 2026 pilot study of injection reported no serious adverse events¹⁷. But safety data are limited. Two reviews of infusion trials found more preterm births after PRP, a signal that is not settled²,¹⁸, and little is known about pregnancies beyond live birth⁴. Ask your doctor about the risks of the procedure itself.

    How thick should my lining be for an embryo transfer?

    A lining under 7 mm is usually called thin⁴. In one large review, clinical pregnancy was 23.3% with a lining of 7 mm or less, against 48.1% above it⁵. But thickness predicts poorly on its own, and with a genetically tested frozen blastocyst, a large study found it does not seem to predict implantation⁶. Your doctor should weigh it with your history.

    Can PRP help Asherman syndrome?

    It may help after the scarring is removed. In a review of 12 studies, adding PRP after hysteroscopic adhesion surgery halved the return of moderate-to-severe adhesions, but did not significantly change live birth rates¹⁶. Severe scarring may respond least: in one small pilot study, two women with severe, repeatedly operated adhesions saw their lining get thinner¹⁷.

    Does PRP help after failed embryo transfers?

    Possibly. Two 2026 meta-analyses of randomized trials in repeated implantation failure reported higher pregnancy and live birth rates with PRP infusion¹⁸,¹⁹, but ESHRE’s 2023 recommendations state that intrauterine PRP infusion is not recommended for this group⁶. We consider PRP after failed transfers when we believe the lining is part of the problem.

    When to Seek a Specialist Evaluation

    Consider a specialist evaluation if your lining has stayed under 7 mm despite adjusted estrogen, if a transfer has been cancelled because of a thin lining, if your periods became much lighter after a D&C or other uterine surgery, or if good embryos have failed to implant more than once. Bring your scan reports, your estrogen protocol, and any hysteroscopy or biopsy results.

    References

    1. Liu X, Qian C, Jiang X, et al. Efficacy of platelet-rich plasma in the treatment of thin endometrium: a meta-analysis of randomized controlled trials. BMC Pregnancy Childbirth. 2024;24(1):567. doi:10.1186/s12884-024-06741-3 PMID 39215227.

    2. Vaidakis D, Papapanou M, Siristatidis CS. Autologous platelet-rich plasma for assisted reproduction. Cochrane Database Syst Rev. 2024;4(4):CD013875. doi:10.1002/14651858.CD013875.pub2 PMID 38682756.

    3. Ma G, Huang W, Zeng X, Qin L, Gao R, Chen J. The value of platelet-rich plasma treatment in reproductive disorders: an umbrella review. Am J Reprod Immunol. 2026;96(2):e70305. doi:10.1111/aji.70305 PMID 42599750.

    4. Kumar P, O’Sullivan R, Walsh H, Marron K, Harrity C. Is sub-endometrial injection a superior method for the administration of intrauterine PRP?: a systematic review and meta-analysis. Reprod Biol Endocrinol. 2025;23(1):151. doi:10.1186/s12884-025-01455-3 PMID 41286777.

    5. Kasius A, Smit JG, Torrance HL, et al. Endometrial thickness and pregnancy rates after IVF: a systematic review and meta-analysis. Hum Reprod Update. 2014;20(4):530-541. doi:10.1093/humupd/dmu011 PMID 24664156.

    6. ESHRE Working Group on Recurrent Implantation Failure, Cimadomo D, de los Santos MJ, et al. ESHRE good practice recommendations on recurrent implantation failure. Hum Reprod Open. 2023;2023(3):hoad023. doi:10.1093/hropen/hoad023 PMID 37332387.

    7. Gargett CE, Schwab KE, Deane JA. Endometrial stem/progenitor cells: the first 10 years. Hum Reprod Update. 2016;22(2):137-163. doi:10.1093/humupd/dmv051 PMID 26552890.

    8. Yu D, Wong YM, Cheong Y, Xia E, Li TC. Asherman syndrome—one century later. Fertil Steril. 2008;89(4):759-779. doi:10.1016/j.fertnstert.2008.02.096 PMID 18406834.

    9. Gleicher N, Vidali A, Barad DH. Successful treatment of unresponsive thin endometrium. Fertil Steril. 2011;95(6):2123.e13-2123.e17. doi:10.1016/j.fertnstert.2011.01.143 PMID 21324451.

    10. Agarwal M, Mettler L, Jain S, Meshram S, Günther V, Alkatout I. Management of a thin endometrium by hysteroscopic instillation of platelet-rich plasma into the endomyometrial junction: a pilot study. J Clin Med. 2020;9(9):2795. doi:10.3390/jcm9092795 PMID 32872571.

    11. Yu TN, Lee TH, Lee MS, et al. Intrauterine infusion and hysteroscopic injection of autologous platelet-rich plasma for patients with a persistent thin endometrium: a prospective case-control study. J Clin Med. 2024;13(10):2838. doi:10.3390/jcm13102838 PMID 38792379.

    12. Zhang W, Tang R, Xiao X, Liu J, Li M, Wang X. A comparative study on the efficacy of subendometrial versus intrauterine platelet-rich plasma injections for treating intrauterine adhesions: a retrospective cohort study. J Minim Invasive Gynecol. 2025;32(4):378-385.e1. doi:10.1016/j.jmig.2024.11.007 PMID 39643206.

    13. Cakiroglu Y, Tohma YA, Yuceturk A, et al. A novel technique- subendometrial autologous platelet rich plasma injection in patients with unresponsive thin endometrium undergoing frozen-thawed embryo transfer: a prospective cohort study. BMC Pregnancy Childbirth. 2025;25(1):297. doi:10.1186/s12884-025-07400-x PMID 40098101.

    14. Noushin MA, Ashraf M, Thunga C, et al. A comparative evaluation of subendometrial and intrauterine platelet-rich plasma treatment for women with recurrent implantation failure. F S Sci. 2021;2(3):295-302. doi:10.1016/j.xfss.2021.03.002 PMID 35560279.

    15. Efendieva Z, Vishnyakova P, Apolikhina I, et al. Hysteroscopic injections of autologous endometrial cells and platelet-rich plasma in patients with thin endometrium: a pilot randomized study. Sci Rep. 2023;13(1):945. doi:10.1038/s41598-023-27982-w PMID 36653431.

    16. Wang G, Zhu Y, Duan N, Guo C, Liu N, Huang H. Does platelet-rich plasma improve adhesion recurrence and pregnancy outcomes in women with intrauterine adhesions? A systematic review and meta-analysis. J Minim Invasive Gynecol. 2025;32(2):133-142.e7. doi:10.1016/j.jmig.2024.10.013 PMID 39454723.

    17. Zhang H, Wang H, Yu J, Huang C, Jiang Y. Subendometrial platelet-rich plasma injection for refractory thin endometrium: a prospective pilot study. Sci Rep. 2026;16(1):9240. doi:10.1038/s41598-026-38286-0 PMID 41699069.

    18. Pan Z, Guo X, Su Q, Ye H. Effects of autologous platelet-rich plasma in recurrent implantation failure: a systematic review and meta-analysis. Front Endocrinol (Lausanne). 2026;17:1730259. doi:10.3389/fendo.2026.1730259 PMID 42058785.

    19. Liang X, Li X, Huang L, Deng Z, Yang Y. Impact of intrauterine infusion of autologous platelet-rich plasma on assisted reproductive outcomes in patients with recurrent implantation failure: a meta-analysis of randomized controlled trials. Reprod Med Biol. 2026;25(1):e70070. doi:10.1002/rmb2.70070 PMID 42440797.

    20. Pinggera GM, Toth B, Colpi GM. Commentary letter to the editor regarding impact of intrauterine infusion of autologous platelet-rich plasma on assisted reproductive outcomes in patients with recurrent implantation failure: a meta-analysis of randomized controlled trials. Reprod Med Biol. 2026;25(1):e70091. doi:10.1002/rmb2.70091 PMID 42621865.

    21. Nazari L, Salehpour S, Hosseini S, Hashemi T, Borumandnia N, Azizi E. Effect of autologous platelet-rich plasma for treatment of recurrent pregnancy loss: a randomized controlled trial. Obstet Gynecol Sci. 2022;65(3):266-272. doi:10.5468/ogs.21261 PMID 35345084.

    22. Stavros S, Potiris A, Daskalaki MA, et al. Platelet-rich plasma in recurrent pregnancy loss: toward a precision medicine framework for biologically guided patient selection. Med Sci (Basel). 2026;14(5):576. doi:10.3390/medsci14050576 PMID 42783449.

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