en تأثیر تزریق داخل رحمی سلول‌های تک هسته‌ای خون محیطی و پلاسمای غنی از پلاکت بر پیامدهای بارداری زنان با تجربه شکست مکرر لانه‌گزینی: یک کارآزمایی بالینی Assisted Reproductive Technologies Original Article Original Article <div style="text-align: justify;"><span style="font-size:12pt"><span style="text-justify:inter-ideograph"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><b><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">مقدمه: </span></span></b><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">شکست مکرر لانه&shy;گزینی را می&shy;توان عمدتاً با تعامل نامناسب بین جنین و آندومتر توضیح داد. تعادل پروفایل </span></span><span dir="LTR" style="font-size:10.0pt">T-helper1/T-helper2</span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:"> بر لانه&shy;گزینی مؤثر جنین تأثیر می&shy;گذارد. تعدیل ایمنی آندومتر از طریق تزریق داخل رحمی سلول‌های تک&shy;هسته‌ای فعال&shy;شده&shy;ی خون محیطی (</span></span><span dir="LTR" style="font-size:10.0pt">PBMCs</span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">) یا پلاسمای غنی از پلاکت اتولوگ (</span></span><span dir="LTR" style="font-size:10.0pt">PRP</span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">) یک گزینه درمانی بالقوه کارآمد است.</span></span></span></span></span></span></span><br> <span style="font-size:12pt"><span style="text-justify:inter-ideograph"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><b><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">هدف:</span></span></b> <span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">هدف اصلی این مطالعه بررسی حاملگی&shy;های بیوشیمیایی و بالینی ناشی از تجویز داخل رحمی </span></span><span dir="LTR" style="font-size:10.0pt">PBMCs</span> <span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">فعال</span></span><span dir="LTR" style="font-size:11.0pt"><span arial="" style="font-family:">&shy;</span></span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">شده و </span></span><span dir="LTR" style="font-size:10.0pt">PRP</span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:"> در زنان </span></span><span dir="LTR" style="font-size:10.0pt">RIF</span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:"> بود.</span></span><b><span dir="LTR" style="font-size:11.0pt"><span style="font-family:"Arial","sans-serif""></span></span></b></span></span></span></span></span><br> <span style="font-size:12pt"><span style="text-justify:inter-ideograph"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><b><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">مواد و روش &shy;ها: </span></span></b><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">این مطالعه کارآزمایی بالینی تصادفی شده دوسوکور در مرکز درمان ناباروری رویا جهاد دانشگاهی استان قم، از نوامبر 2022 تا آپریل 2024 انجام شد. 96 زن با حداقل 2 مورد </span></span><span dir="LTR" style="font-size:10.0pt">RIF</span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:"> پس از لقاح آزمایشگاهی بطور تصادفی در گروه&shy;های کنترل، </span></span><span dir="LTR" style="font-size:10.0pt">PBMC</span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:"> و </span></span><span dir="LTR" style="font-size:10.0pt">PRP</span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:"> قرار گرفتند. به طور خلاصه، 3 میلی‌لیتر نمونه خون جمع‌آوری شد و </span></span><span dir="LTR" style="font-size:10.0pt">PBMC</span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:"> ها با استفاده از محلول جداسازی </span></span><span dir="LTR" style="font-size:10.0pt">Ficoll</span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:"> جدا شده و به مدت 72 ساعت کشت داده شدند. </span></span><span dir="LTR" style="font-size:10.0pt">PRP</span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:"> با استفاده از سانتریفیوژ و از 10 میلی&shy;لیتر خون محیطی جدا شد. دو روز قبل از انتقال جنین، </span></span><span dir="LTR" style="font-size:10.0pt">PBMC</span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:"> ها یا </span></span><span dir="LTR" style="font-size:10.0pt">PRP</span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:"> به داخل حفره آندومتر منتقل شدند.</span></span></span></span></span></span></span><br> <span style="font-size:12pt"><span style="text-justify:inter-ideograph"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><b><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">نتایج: </span></span></b><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">به جز مدت زمان ناباروری که در گروه </span></span><span dir="LTR" style="font-size:10.0pt">PBMC</span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:"> بیشتر از گروه کنترل بود، سایر خصوصیات پایه از نظر آماری تفاوتی نداشتند. همچنین میزان حاملگی بیوشیمیایی در گروه </span></span><span dir="LTR" style="font-size:10.0pt">PRP</span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:"> (32/10) و</span></span><span dir="LTR" style="font-size:10.0pt">PBMC </span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">&nbsp;(32/12) در مقایسه با گروه شاهد (32/3) به طور قابل توجهی بالاتر بود (027/0 </span></span><span lang="FA" style="font-size:10.0pt">= </span><span dir="LTR" style="font-size:10.0pt">p</span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">)، در حالی که میزان حاملگی بالینی فقط در گروه</span></span><span dir="LTR" style="font-size:10.0pt">PBMC</span> <span style="font-size:11.0pt"><span b="" mitra="" style="font-family:">&nbsp;(32/10) به طور معنی</span></span><span dir="LTR" style="font-size:11.0pt"><span arial="" style="font-family:">&shy;</span></span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">داری بالاتر از گروه کنترل (32/2) بود (038/0 </span></span><span lang="FA" style="font-size:10.0pt">= </span><span dir="LTR" style="font-size:10.0pt">p</span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">).</span></span></span></span></span></span></span><br> <span style="font-size:12pt"><span style="text-justify:inter-ideograph"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><b><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">نتیجه&shy; گیری: </span></span></b><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">نه مداخلات </span></span><span dir="LTR" style="font-size:10.0pt">PBMC</span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:"> و نه </span></span><span dir="LTR" style="font-size:10.0pt">PRP</span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:"> برتری قابل توجهی نسبت به یکدیگر در مورد میزان بارداری بیوشیمیایی و بالینی نشان ندادند.</span></span><b><span dir="LTR" style="font-size:11.0pt"><span style="font-family:"Arial","sans-serif""></span></span></b></span></span></span></span></span><br> <br> <span style="position:absolute; margin-left:-11px; margin-top:12px; width:200px"><span style="z-index:251658240"><span style="height:2px"><img alt="" src="file:///C:UsersITAppDataLocalTempOICE_5901726E-5249-4BD5-AA3F-7749EA9ABA5D.0msohtmlclip1�1clip_image001.gif" style="width:200px; height:2px" ></span></span></span></div> <div style="text-align: justify;"><span style="font-family:Times New Roman;"><span style="font-size:11pt"><span style="line-height:normal"><a name="_Hlk177897140"><b><span style="font-size:12.0pt">Background:</span></b></a><span style="font-size:12.0pt"> Recurrent implantation failure (RIF) can be explained mainly by improper crosstalk between the embryo and endometrium. The T-helper1/T-helper2 profile balance influences effective embryo implantation. Endometrial immunomodulation via intrauterine injection of activated peripheral blood mononuclear cells (PBMCs) or autologous platelet-rich plasma (PRP) is a potentially efficient treatment option.</span></span></span><br> <span style="font-size:11pt"><span style="line-height:normal"><b><span style="font-size:12.0pt">Objective: </span></b><span style="font-size:12.0pt">This study aims to examine the biochemical and clinical pregnancies resulting from the intrauterine administering of activated PBMCs and PRP in RIF women.</span></span></span><br> <span style="font-size:11pt"><span style="line-height:normal"><b><span style="font-size:12.0pt">Materials and Methods:</span></b><span style="font-size:12.0pt"> This randomized clinical trial study was done in the Rooya Infertility Treatment Center, Qom, Iran from November 2022 to April 2024. 96 women with at least 2 RIFs were randomized into control, PBMC, and PRP groups. Briefly, 3 ml of blood sample was collected and PBMCs were isolated using Ficoll separation solution, and cultured for 72 hr. PRP was separated from 10 ml of peripheral blood through centrifugation. 2 days before embryo transfer PBMCs or PRP were transferred into the endometrial cavity. </span></span></span><br> <span style="font-size:11pt"><span style="line-height:normal"><b><span style="font-size:12.0pt">Results:</span></b> <span style="font-size:12.0pt">Except for the duration of infertility, which was higher in the PBMC group, all other baseline characteristics were not statistically different. Moreover, a significantly higher rate of biochemical pregnancy was observed in the PRP (10/32) and PBMC (12/32) groups compared to the control (3/32) (p = 0.027), while the rate of clinical pregnancy was only significantly higher in the PBMC group (10/32) than in the control group (2/32) (p = 0.038).</span></span></span><br> <span style="font-size:11pt"><span style="line-height:normal"><b><span style="font-size:12.0pt">Conclusion:</span></b> <span style="font-size:12.0pt">Neither PBMC nor PRP interventions exhibited a substantial advantage over one another regarding biochemical and clinical pregnancy rates.</span></span></span></span><br> <br> <span style="font-family:Times New Roman;"><span style="font-size:11pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:"Times New Roman","serif""></span></span></span></span></span></div> <div style="text-align: center;"><span style="font-size:14px;"><span style="font-family:Times New Roman;"><span style="line-height:normal"><b><i>Registration ID in IRCT: IRCT20221010056132N1</i></b></span></span></span></div> سلول­های تک­هسته­ای خون محیطی, پلاسمای غنی از پلاکت, شکست مکرر لانه­گزینی, حاملگی. Peripheral blood mononuclear cells, Platelet-rich plasma, Recurrent implantation failure, Pregnancy. 801 810 http://ijrm.ir/browse.php?a_code=A-10-49-2&slc_lang=en&sid=1 Hoda Fazaeli hodafazaely@yahoo.com 0000-0003-4724-2106 No Department of Cell Biology and Regenerative Medicine, Academic Center for Education, Culture, and Research (ACECR), Qom Branch, Qom, Iran. Azar Sheikholeslami azareslami10@gmail.com 0000-0001-8277-6539 No Department of Cell Biology and Regenerative Medicine, Academic Center for Education, Culture, and Research (ACECR), Qom Branch, Qom, Iran. Zahra Ebrahimi Dr.zahra.ebrahimi@gmail.com 0000-0001-9452-5737 No Department of Reproductive Biology, Academic Center for Education, Culture, and Research (ACECR), Qom Branch, Qom, Iran. Naser Kalhor naserkalhor@gmail.com 0000-0001-8870-8035 No Department of Cell Biology and Regenerative Medicine, Academic Center for Education, Culture, and Research (ACECR), Qom Branch, Qom, Iran. Leila Naserpour naserpour@acecr.ac.ir 0000-0003-0565-1729 Yes Department of Reproductive Biology, Academic Center for Education, Culture, and Research (ACECR), Qom Branch, Qom, Iran.