Where next?
Back to Treatment add-ons information
The CMA’s guide for patients paying for fertility treatment
Questions to ask your clinic about treatment add-ons
Understanding ovarian reserve (The British Fertility Society)
Platelet-rich plasma (PRP)
For most patients, having a routine cycle of proven fertility treatment is effective without using any treatment add-ons.
Our ratings indicate whether the evidence from studies shows that a treatment add-on is effective at improving treatment outcomes for someone undergoing fertility treatment. Our rating does not tell you how much that treatment add-on improves your chances of having a baby – please discuss this with your clinic.
What is platelet-rich plasma?
Platelet-rich plasma, otherwise known as PRP, is taken from a sample of a patients’ own blood. Blood is taken from the patient and placed in a centrifuge machine which spins the blood to separate the red blood cells from plasma - the liquid portion of blood. Plasma contains tiny cell fragments known as platelets that produce substances called growth factors that help cells grow and repair. This concentrated plasma is then transferred (injected) back into the patient into the area being treated.
For fertility patients, PRP is being explored as a treatment to improve the health of the uterus or function of the ovaries. It is currently offered in the following ways, with the aim of improving the chances of having a baby:
- Intrauterine injection/infusion – PRP is injected directly into the womb in the hope that it encourages the lining (endometrium) to grow thicker and become more receptive for an embryo to implant.
- Intraovarian injection – PRP is injected directly into the ovaries with the aim of helping the tissue respond better to ovarian stimulation and potentially increase the number of eggs retrieved.
The Medicines and Healthcare products Regulatory Agency (MHRA) regulate the use of PRP in respect of standards of quality and safety.
| Rated outcomes for intraovarian injection of platelet-rich plasma | |
|---|---|
| Not rated for increasing the chances of having a baby for most fertility patients | A rating has not been allocated to indicate if this add-on increases the chances of having a baby for most fertility patients because there is no good medical reason for why it should be offered to most fertility patients. |
| Rated red for increasing the chances of having a baby for patients with poor or diminished ovarian reserve
Red traffic light
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For patients with poor or low number of eggs (diminished ovarian reserve), the use of intraovarian injection of PRP is rated red for improving the chances of having a baby. This is because there are potential safety concerns, and there is no moderate/high quality evidence to show that this add-on is effective at improving treatment outcomes. |
| Rated outcomes for intrauterine infusion/injection of platelet-rich plasma | |
|---|---|
| Not rated for increasing the chances of having a baby for most fertility patients | A rating has not been allocated to indicate if this add-on increases the chances of having a baby for most fertility patients because there is no good medical reason for why it should be offered to most fertility patients. |
| Rated red for increasing the chances of having a baby for patients with thin or refractory endometrium
Red traffic light
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For patients with thin or refractory uterine lining (endometrium) the use of intrauterine infusion/injection of PRP is rated red for improving the chances of having a baby. This is because there are potential safety concerns, and there is no moderate/high quality evidence to show that this add-on is effective at improving treatment outcomes. |
| Rated red for increasing the chances of having a baby for patients with recurrent or repeated implantation failure
Red traffic light
|
For patients with recurrent or repeated implantation failure, the use of intrauterine infusion/injection of PRP is rated red for improving the chances of having a baby. This is because there are potential safety concerns, and there is no moderate/high quality evidence to show that this add-on is effective at improving treatment outcomes. |
| Rated red for increasing the chances of having a baby for patients with Asherman’s syndrome or intrauterine adhesions
Red traffic light
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For patients with Asherman’s syndrome or intrauterine adhesions, the use of intrauterine infusion/injection of PRP is rated red for improving the chances of having a baby. This is because there are potential safety concerns, and there is no moderate/high quality evidence to show that this add-on is effective at improving treatment outcomes. |
| Rated red for increasing the chances of having a baby for patients with recurrent pregnancy loss
Red traffic light
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For patients with recurrent pregnancy loss, the use of intrauterine infusion/injection of PRP is rated red for improving the chances of having a baby. This is because there are potential safety concerns, and there is no moderate/high quality evidence to show that this add-on is effective at improving treatment outcomes. |
Specific safety concerns about a treatment add-on, including those discussed above, are included under the dedicated section titled Is this treatment add-on safe?.
What do ratings mean?
There are five ratings that indicate whether a treatment add-on is effective at improving treatment outcomes for someone undergoing fertility treatment, according to the evidence from studies. To make it easier to understand the scientific evidence for each treatment add-on, we have a range of symbols and colours for each rated add-on below.
Green traffic light
On balance, findings from high quality evidence shows this add-on is effective at improving the treatment outcome.
Yellow traffic light
On balance, it is not clear whether this add-on is effective at improving the treatment outcome. This is because there is conflicting moderate/high quality evidence – in some studies the add-on has been found to be effective, but in other studies it has not.
Grey traffic light
We cannot rate the effectiveness of this add-on at improving the treatment outcome as there is insufficient moderate/high quality evidence.
Black traffic light
On balance, the findings from moderate/high quality evidence shows that this add-on has no effect on the treatment outcome.
Red traffic light
There are potential safety concerns and/or, on balance, findings from moderate/high quality evidence shows that this add-on may reduce treatment effectiveness.
All treatment add-ons on our list will have a rating to indicate whether the evidence shows that the treatment add-on is effective at improving the chances of having a baby for most fertility patients. Some treatment add-ons on our list may also have additional ratings for specific treatment outcomes. For example, whether the evidence shows that the treatment add-on reduces miscarriage. There may also be further ratings for specific patient groups, for example whether the evidence shows that the treatment add-on is effective for those who are aged over 40. Please see the individual webpages for each treatment add-on for their ratings.
An agreement between the HFEA and other professional and patient bodies (the 19th October 2023 consensus statement) states that treatments that have no strong evidence of their safety and/or effectiveness should only be offered in a research setting. Patients should not be charged extra to take part in research, including clinical trials.
What’s the evidence for platelet-rich plasma?
Intraovarian injection
There is insufficient reliable evidence to indicate that intraovarian injection of PRP would be of any benefit to patients.
- The majority of studies looking at its use in women with poor or diminished ovarian reserve are of low quality and involved only a small number of patients.
- Results are inconsistent across studies and collectively they do not show any impact on increasing the chances of having a baby.
- The only study considered to be of moderate/high quality included a small number of patients and showed no improvements in terms of having a baby for patients treated with intraovarian PRP.
- Studies also reported on secondary outcomes such as, the number of eggs and embryos produced, and on ovarian reserve, however, these results are not consistent across studies.
Intrauterine injection/infusion
There is also insufficient evidence to suggest that intrauterine injection/infusion of PRP improves the chances of having a baby for patients with thin/refractory endometrium, recurrent/repeated implantation failure, Asherman’s syndrome/intrauterine adhesions and recurrent pregnancy loss.
At the October 2025 meeting, the Scientific and Clinical Advances Advisory Committee (SCAAC) evaluated the evidence for both intraovarian and intrauterine PRP. Details of the evidence considered and the Committee’s discussions can be found here: SCAAC papers October 2025 (pages 23-46) and SCAAC minutes October 2025 (pages 8-10).
A 2024 Cochrane review of PRP also provides further information.
Is this treatment add-on safe?
Almost all studies investigating the use of intrauterine and intraovarian PRP in fertility treatment did not evaluate patient safety. Of the six studies that did touch on safety, all focused on tolerability, meaning, how manageable the treatment feels, rather than whether it can cause harm.
Safety concerns have been raised by the HFEA’s SCAAC in relation to the preparation of PRP and the techniques involved in administering intraovarian and intrauterine PRP.
- There are currently no standardised guidelines or training requirements for PRP procedures, resulting in variability in how the plasma product is prepared and administered.
- There is a risk of side effects such as, infection, bleeding or allergic reaction, especially when the plasma product is not prepared in a sterile way.
- There is limited information about whether the PRP stays in the intended area after it is injected and how PRP might affect eggs or embryos.
- Intraovarian PRP may be associated with additional risks linked to the use of anaesthetic and to trauma including bleeding and infection due to injection of the product directly into the ovaries.
If you have any questions about the safety and risks of this treatment add-on, your clinic will be able to discuss the use of a treatment add-on with you, taking into account your specific medical history and circumstances.
Studies reviewed for this treatment add-on
The SCAAC have reviewed the following studies for Intraovarian PRP:
| Poor ovarian reserve: | Stojkovska 2019 | 10.3889/oamjms.2019.825 |
| Melo 2020 | 10.1007/s10815-020-01710-z | |
| Keikha 2022 | 10.4314/ejhs.v32i6.10 | |
| Herlihy 2022 | 10.1016/j.fertnstert.2022.09.330 | |
| Barrenetxea 2024 | 10.1093/humrep/deae038 | |
| Barad 2024 | 10.1093/humrep/deae108.954 | |
| Peng 2025 | 10.11817/j.issn.1672-7347.2025.240408 | |
| Yu 2025 | 10.1038/s41598-024-82630-1 |
The SCAAC have reviewed the following studies for Intrauterine PRP:
| Thin/refractory endometrium: | Eftekhar 2018 | 10.1016/j.tjog.2018.10.007 |
| Nazari 2019 | 10.18502/ijrm.v17i6.4816 | |
| Abduljabbar 2022 | 10.7759/cureus.27913 | |
| Pandey 2023 | 10.1016/j.xagr.2023.100172 | |
| Zhang 2025 | PMID: 40340871 | |
| Recurrent/repeated implantation failure: | Obidniak 2017 | 10.1016/j.fertnstert.2017.07.1080 |
| Alhalabi 2019 | 10.1093/humrep/34.Supplement_1.1 | |
| Nazari 2020 | 10.1080/14647273.2019.1569268 | |
| Rageh 2020 | 10.21608/ebwhj.2019.17936.1039 | |
| Zamaniyan 2020 | 10.1080/09513590.2020.1756247 | |
| Allahveisi 2020 | 10.1016/j.heliyon.2020.e03577 | |
| Tehraninejad 2020 | 10.1111/jog.14445 | |
| Zargar 2021 | 10.31083/j.ceog.2021.01.2131 | |
| Safdarian 2022 | 10.15296/ijwhr.2022.08 | |
| Bakhsh 2022 | 10.5935/1518-0557.20210046 | |
| Nazari 2022 | 10.1007/s43032-021-00669-1 | |
| El-Samman 2022 | 10.21608/aimj.2022.92034.1557 | |
| Ershadi 2022 | 10.4103/jfmpc.jfmpc_1817_21 | |
| Baybordi 2022 | 10.18502/ijrm.v20i9.12065 | |
| Yahyaei 2024 | 10.1038/s41598-024-77578-1 | |
| Eftekhar 2024 | 10.22074/ijfs.2023.553636.1305 | |
| Strug 2024 | 10.1016/j.fertnstert.2024.05.121 | |
| Fazaeli 2024 | 10.18502/ijrm.v22i10.17668 | |
| Aherman’s syndrome/intrauterine adhesions: | Peng 2020 | 10.1002/ijgo. 13353 |
| Ahmed 2021 | 10.18203/2320-1770.ijrcog20210289 | |
| Aghajanova 2021 | 10.1007/s10815-021-02328-5 | |
| Recurrent pregnancy loss: | Nazari 2022b | 10.5468/ogs.21261 |
Other reviews include:
| Cochrane: | Vaidakis 2024 | 10.1002/14651858.CD013875.pub2 |
| Evidence-based IVF: | https://www.unimelb.edu.au/ivf/treatment |
What are treatment add-ons?
In vitro fertilisation (IVF) and intrauterine insemination (IUI) are established treatments that have been proven effective for most patients. Treatment add-ons are optional non-essential treatments or tests that may be offered in addition to such proven fertility treatment. Treatment add-ons are:
- Additional treatments (to the core treatment e.g. IVF or IUI) or tests that are being offered to the general patient population in licensed fertility clinics in the UK,
- where there is published scientific literature which claims to demonstrate that the add-on improves live birth rates or other treatment outcomes rated by the HFEA; but
- where evidence of effectiveness for the use of the treatment or test in a clinical setting is lacking or absent; and
- where patients need unbiased information about the effectiveness and risks of this treatment or test
It is important to keep in mind that for most patients, having routine cycles of proven fertility treatment are effective without using any treatment add-ons. If you are paying for your own treatment, you may want to think about whether it might be better to pay for multiple cycles of IVF or IUI, rather than spending large sums of money on a single treatment cycle with treatment add-ons that haven’t been proven to be effective.
We aim to publish clear and reliable information about some of the treatment add-ons that don’t have enough evidence to show that they improve your chances of having a baby and other relevant treatment outcomes. This provides useful information to patients and allows them to question the use of add-ons.
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