A narrative review of platelet-rich plasma (PRP) in reproductive medicine

Sharara, Fady I.; Lelea, Latashia-Lika; Rahman, Sara; Klebanoff, Jordan S.; Moawad, Gaby

doi:10.1007/s10815-021-02146-9

Cited by 76 publications

(64 citation statements)

References 36 publications

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“…After centrifugation of a subject’s whole blood, it is possible to collect plasma that has high concentrations of platelets, called platelet-rich plasma (PRP), which may subsequently be reinjected into the subject at specific injured sites, a process referred to as autologous PRP injection. This process has been known for more than 50 years, and has previously demonstrated a certain degree of efficacy in some health conditions requiring tissue healing and regeneration, notably in orthopedics, cardiothoracic surgery, plastic surgery, dermatology, dentistry, and diabetic wound healing [ 6 ]. The mechanism of action of PRP is complex and remains incompletely understood: after activation, platelets release a series of cytokines, growth factors, and hormones, capable, among other actions, of attracting stem cells, enhancing angiogenesis, and activating cellular differentiation and proliferation [ 7 ].…”

Section: Resultsmentioning

confidence: 99%

“…Surprisingly, very few attempts at using PRP have been undertaken in the gynecological field until recently, when it was suggested as a means to improve pregnancy rates in some women with thin endometrial lining and recurrent implantation failures, and in some poor responders. These studies have been well-summarized by Sharara et al in a 2021 review [ 6 ].…”

Section: Resultsmentioning

confidence: 99%

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Restoration of Fertility in Patients with Spontaneous Premature Ovarian Insufficiency: New Techniques under the Microscope

Mawet¹,

d'HAUTERIVE

Henry³

et al. 2021

JCM

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Premature ovarian insufficiency (POI), a condition affecting up to 1% of women by the age of 40 years, is characterized by an extremely low chance of spontaneous pregnancy. Currently, fertility restoration options are virtually nonexistent for this population. To become pregnant, the only solution is egg donation. Interestingly, animal studies have provided encouraging results in terms of fertility restoration, and consequently, research has begun into the most promising approaches for women suffering from POI. The PubMed database was searched for studies in which techniques aiming at restoring fertility in women with spontaneous POI were tested. Although robust studies are lacking, the literature suggests a positive effect of certain techniques on fertility restoration in women with POI. The most promising approaches seem to be intraovarian injection of autologous platelet-rich plasma or of mesenchymal stem cells. In addition to these, in vitro and mechanical activation of dormant follicles and etiology-driven therapies have also been studied with mixed results. No safety concerns were raised in these studies. The absence of robust studies does not allow us to draw meaningful conclusions on the efficacy or superiority of any single technique at this stage, and so research in this area should continue using robust study designs, i.e., multicenter randomized controlled trials including sufficient subjects to achieve statistical power.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Restoration of Fertility in Patients with Spontaneous Premature Ovarian Insufficiency: New Techniques under the Microscope

Mawet¹,

d'HAUTERIVE

Henry³

et al. 2021

JCM

View full text Add to dashboard Cite

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“…This is maybe explained by the associated endothelial dysfunction with some vasculopathy disorders such as diabetes and/or nerve damage linked to post-radical prostatectomy (Mostafa et al, 2020;Wang et al, 2021). In this context, PRP was lately introduced whereas the that serves as a scaffold for cell migration, differentiation and proliferation (Sharara et al, 2021). F I G U R E 2 Mean IIEF-5 score improvement at baseline and after PRP therapy in the investigated ED patients.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, stimulation of fibroblasts and endothelial cells induces new extracellular matrix deposition and neo‐vascularization. Besides, the plasma is essential for cell survival as it contains nutrients, vitamins, hormones, electrolytes and proteins that are the key molecules for the coagulation process and formation of fibrin polymer that serves as a scaffold for cell migration, differentiation and proliferation (Sharara et al, 2021).…”

Section: Discussionmentioning

confidence: 99%

Assessment of the intracavernosal injection platelet‐rich plasma in addition to daily oral tadalafil intake in diabetic patients with erectile dysfunction non‐responding to on‐demand oral PDE5 inhibitors

et al. 2022

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This study aimed to evaluate the effectiveness of ICI of platelet‐rich plasma (PRP) in addition to daily oral tadalafil intake in diabetic erectile dysfunction (ED) patients non‐responding to PDE5 inhibitors. Overall, 48 patients complaining of ED non‐responding to on‐demand PDE5 inhibitors were allocated into 2 equal groups, diabetics and non‐diabetics that were given a daily dose of 5 mg tadalafil plus vardenafil 20 mg on demand during the study besides being subjected to 3 doses of ICI of PRP, 4 weeks apart. Responses to on‐demand PDE5 inhibitors, International index of erectile function‐5 (IIEF‐5) score, erection hardness scores (EHS) and pharmaco‐dynamic duplex studies were assessed. After PRP injections, 33% and 50% of cases were satisfied with on‐demand PDE5 inhibitors, respectively, whereas 41% and 66% of them showed improved EHS response. Compared with baseline scores, the mean IIEF‐5 scores were significantly improved after PRP therapy in the diabetic ED group (12.1 vs. 8.04, p = 0.003) as well as in the non‐diabetic ED group (14.8 vs. 10.2, p = 0.001) linked to pharmaco‐penile duplex readings. Both good and fair diabetic control exhibited significant responses to ICI therapy of PRP compared with bad controlled cases. The significant improvement included; the IIEF‐5 score increase (86.7%, 126% vs. 16.1%), improved EHS as well as penile duplex readings. Baseline HbA1C demonstrated a significant negative correlation with IIEF‐5 score before (p = 0.019) and after PRP therapy (p = 0.002) respectively. It could be concluded that ICI of PRP could be an effective therapy for treating ED patients non‐responding to on‐demand oral PDE5 treatment.

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“…The current leading hypothesis suggests that undefined growth factors released from platelets may induce the transformation of germline stem cells into primordial follicles, thus replenishing a diminished follicle pool ( Sills and Wood, 2019 ). Evidence for this hypothesis, however, is sparse ( McRedmond et al ., 2004 ; Macaulay et al ., 2005 ; Sánchez-González et al ., 2012 ; Pantos et al ., 2016 ; Hosseini et al ., 2017 ; Sills et al ., 2018 ; Farimani et al ., 2019 ; Pantos et al ., 2019 ; Sharara et al ., 2021 ) and mostly limited to case reports of pregnancies in women with alleged primary ovarian failure (also called primary ovarian insufficiency, POF/POI) ( Pantos et al ., 2016 ; 2019 ), and often includes cases that do not even fully qualify for such a diagnosis and/or have other limitations ( Sharara et al ., 2021 ). Even if effects are seen after PRP injection, it remains possible that simple mechanical disruption, and not platelet growth factors, could be responsible for the cases of observed follicular activation ( Hsueh and Kawamura, 2020 ).…”

Section: Introductionmentioning

confidence: 99%

Preliminary report of intraovarian injections of autologous platelet-rich plasma (PRP) in extremely poor prognosis patients with only oocyte donation as alternative: a prospective cohort study

Barad

Albertini

Molinari

et al. 2022

Human Reproduction Open

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STUDY QUESTION Does intraovarian injection of platelet-rich plasma (PRP) change ovarian function in patients with extremely low functional ovarian reserve (LFOR) who, otherwise, would likely only have a chance of pregnancy through third-party oocyte donation? SUMMARY ANSWER No clinically significant effects of PRP treatment on ovarian function were observed over 1 year of follow-up. WHAT IS KNOWN ALREADY Several investigators have reported improved responses to ovulation induction after treatment with PRP. However, previous published reports have involved, at most, only small case series. Whether PRP actually improves ovarian performance is, therefore, still unknown. PRP is nevertheless widely offered as an ‘established’ fertility treatment, often under the term ‘ovarian rejuvenation’. STUDY DESIGN, SIZE, DURATION We are reporting a prospective cohort study of 80 consecutive patients at ages 28–54 with LFOR, defined by anti-Müllerian hormone <1.1 ng/ml, FSH >12 mIU/ml or at least one prior IVF cycle with ≤3 oocytes within 1 year. The women were followed for 1 year after an intraovarian PRP procedure. PARTICIPANTS/MATERIALS, SETTING, METHODS PRP (1.5 ml) was injected into the cortex of ovaries with an average of 12 injections per ovary. Study participants were followed every 3 days for 2 weeks after PRP treatment with estradiol and FSH measurements and vaginal ultrasound to observe follicle growth and thereafter followed weekly. Beginning 1 month after their PRP treatment, participants underwent one or more cycles of ovarian stimulation for IVF. Outcome measures were endocrine response, and numbers of oocytes and embryos produced in response to a maximal gonadotropin stimulation before and after PRP treatment. MAIN RESULTS AND THE ROLE OF CHANCE In this study, women failed to demonstrate statistically significant outcome benefits from intraovarian PRP. However, two 40-year-old very poor-prognosis patients, with prior failed IVF cycles that never reached embryo transfer at other centers, achieved pregnancy, resulting in an ongoing pregnancy rate of 4.7% among patients who, following PRP, produced at least one oocyte (n = 42). LIMITATIONS, REASONS FOR CAUTION As an observational study of patients who performed poorly in past ovarian stimulation cycles, the improvement may be accounted for by regression to the mean. Similar considerations may also explain the occurrence of the two pregnancies. WIDER IMPLICATIONS OF THE FINDINGS This study demonstrates that, even in extremely poor prognosis patients due to LFOR, sporadic pregnancies are possible. The study, however, does not allow for the conclusion that those pregnancies were the consequence of PRP treatments. A case series, indeed, does not allow for such conclusions, even if results are more suggestive than here. This registered study, therefore, must be viewed as a preliminary report, with further data expected from this study but also from two other prospectively randomized ongoing registered studies with more controlled patient selection. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by intramural funds from The Center for Human Reproduction and the not-for-profit research Foundation for Reproductive Medicine, both in New York, NY, USA. N.G. and D.H.B. are listed as co-inventors on several US patents. Some of these patents relate to pre-supplementation of hypo-androgenic infertile women with androgens, such as dehydroepiandrosterone and testosterone and, therefore, at least peripherally relate to the subject of this manuscript. They, as well as D.F.A., have also received research support, travel funds and speaker honoraria from several pharmaceutical and medical device companies, though none related to the here presented subject and manuscript. N.G. is a shareholder in Fertility Nutraceuticals and he and D.H.B. receive royalty payments from Fertility Nutraceuticals LLC. E.M. has no conflicts of interest to declare. TRIAL REGISTRATION NUMBER NCT04275700

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A narrative review of platelet-rich plasma (PRP) in reproductive medicine

Cited by 76 publications

References 36 publications

Restoration of Fertility in Patients with Spontaneous Premature Ovarian Insufficiency: New Techniques under the Microscope

Restoration of Fertility in Patients with Spontaneous Premature Ovarian Insufficiency: New Techniques under the Microscope

Assessment of the intracavernosal injection platelet‐rich plasma in addition to daily oral tadalafil intake in diabetic patients with erectile dysfunction non‐responding to on‐demand oral PDE5 inhibitors

Preliminary report of intraovarian injections of autologous platelet-rich plasma (PRP) in extremely poor prognosis patients with only oocyte donation as alternative: a prospective cohort study

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