Abstract:

Objective To compare the clinical pregnancy outcomes of tamoxifen （TAM） ， TAM combined with intrauterine perfusion of platelet-rich plasma （PRP）， and hormone replacement therapy （HRT） combined with intrauterine perfusion of PRP for frozen-thawed embryo transfer （FET） in patients with thin endometrium. Methods A retrospective analysis was performed on clinical data of 321 patients with thin endometrium （endometrial thickness ≤ 7 mm in previous cycles） who underwent FET at the Reproductive Medicine Center of Guangdong Provincial Reproductive Hospital from January 2023 to April 2025. According to the treatment protocols，the patients were divided into three groups： TAM group （Group A， n = 98）， TAM + PRP group （Group B， n = 91）， and HRT + PRP group （Group C， n = 132）. General information， endometrial thickness on the conversion day before and after treatment， clinical pregnancy outcomes， andcosts of endometrial preparation treatment were compared among the three groups. Results There were no significant differences in age， duration of infertility， type of infertility， anti-Müllerian hormone （AMH） level， basal follicle-stimulating hormone （FSH） among the three groups（P > 0.05）. After treatment， there were no significant differences in endometrial thickness on the conversion day or the extent of increase among the three groups（P > 0.05）. The clinical pregnancy rates in Group A， Group B， and Group C were 56.1%， 51.6%， and 43.2% respectively， with a significant difference （P = 0.011）； the embryo implantation rates were 43.6%， 45.5%， and 34.6% respectively， showing a significant difference（P = 0.019）. The early abortion rate in Group A （3.64%） was significantly lower than that in Group C （15.79%）（P < 0.01）. In terms of treatment cost of endometrial preparation treatment， the cost in Group A （676.5 ± 494.5 Yuan） was significantly lower than that in Group B （2 401.2 ± 764.2 Yuan） and Group C （3 093.8 ± 758.3 Yuan） （P < 0.01）. Conclusion In FET cycles for patients with thin endometrium， the clinical outcomes of TAM，TAM + PRP and HRT + PRP are comparable， and TAM demonstrates advantages in terms of a lower early miscarrage rate and better cost-effectiveness， thus serving as an option for endometrial preparation in patients with thin endometrium.

Key words: thin endometrium, tamoxifen, platelet-rich plasma, hormone replacement therapy, intrauterine perfusion