A Case Series on Platelet-Rich Plasma Revolutionary Management of Poor Responder Patients

Abstract

Poor responders are described as those In Vitro Fertilization (IVF) patients who are failing to respond to controlled ovarian stimulation protocols. Extensive research has focused on crafting the optimal treatment. However, it appears that each approach fails to be established as effective or guaranteed towards successful management. Platelet-Rich Plasma (PRP) is a novel, highly promising approach that has been successfully applied for an array of medical issues. In this case series, we present 3 poor responder patients with the common denominator of: failed IVF attempts, poor oocyte yield, and poor embryo quality. The option of oocyte donation was rejected. All patients were treated with autologous PRP ovarian infusion following written consent. Within a 3-month interval, follicle-stimulating hormone decreased by 67.33%, while Anti-Müllerian hormone increased by 75.18%. These impressive results on the biochemical infertility markers alone are classified as a complete biological paradox, coupled by improved embryo quality. Results report a natural conception at 24 weeks, an uncomplicated healthy pregnancy at 17 weeks and a successful live birth. To our knowledge, this is the first time such an approach and results are reported, where PRP treatment on poor responders lead to overcoming their challenging reproductive barrier.

Regenerative Effect of Intraovarian Injection of Activated Autologous Platelet Rich Plasma: Serum Anti-Mullerian Hormone Levels Measured Among Poor-Prognosis In Vitro Fertilization Patients

“…Using this approach, we described four poor-prognosis IVF patients (mean age 42yrs) who had been consigned to donor oocyte treatment-all produced blastocysts from their own eggs after ovarian PRP and one has since undergone thaw, transfer, and healthy term delivery [5]. Six months later, experts in Greece reported on three poorresponder IVF patients (mean age 38yrs) with similar "revolutionary" outcomes [4]. Of note, or at least one patient with a history of producing consecutive aneuploid embryos intraovarian injection of platelet-derived growth factors before IVF achieved what appeared to be a qualitative "ploidy rescue", with subsequent healthy term delivery [11].…”

“…These descriptive findings would have been strengthened by comparisons with a matched control group. How ovarian PRP patients perform later in ovulation induction and IVF is now only just beginning to be studied [4,5,16]. While non-reproductive use of intraovarian PRP was outside the scope of this clinical trial, estradiol and testosterone are both ovarian modulators of female sexual and neurobehavioral response and appear to be substantially enhanced after PRP treatment [25][26][27][28].Familiarity with PRP used in other clinical settings has prompted awareness and wider acceptance of this technology by IVF patients.…”

“…Of note, even before patient enrollment closed, intraovarian application of autologous PRP was occasionally noted to alter ovarian reserve, permit retrieval of oocytes, culture and transfer of embryos. Moreover, reproductive outcomes after similar PRP techniques described in two early reports were favorable, underscoring the urgent need for further research [4,5]. Thus, the current descriptive, prospective clinical trial aimed to improve the understanding of this treatment and offer insights as to why it might be useful for poor-prognosis fertility patients.…”

Successful Implantation and Live Birth Following Autologous Platelet-rich Plasma Treatment for a Patient with Recurrent Implantation Failure and Chronic Endometritis

“…The use of PRP in the reproductive context was pioneered by our team and cited by Sills and colleagues (48). Further to that, two case series have been published reporting on ovarian rejuvenation following intraovarian PRP infusion in women characterized as either peri-menopausal (49), or of poor ovarian response (50). Regarding this case report, what should be further highlighted as strengthening the cause and effect association between PRP and treatment of CE enabling pregnancy and live birth is the fact that the quality of the donated embryos that led to a miscarriage was in fact superior when compared to the quality of the embryos that actually resulted in live birth following PRP treatment.…”

Effects of Autologous Platelet-Rich Plasma on Endometrium Thickness and Pregnancy Rates During Intrauterine Insemination

“…Although PRP has found widespread use for tissue healing, especially in areas such as ophthalmology, orthopedics and plastic surgery, there are very limited number of existing studies in the field of infertility. (Dhillon et al, 2012;Chang et al, 2015;Ronci et al, 2015;Garcia-Velasco et al, 2016;Sfakianoudis et al, 2018).…”