Live Birth After an Autologous Platelet-Rich Plasma Ovarian In Vitro Activation and Bone Marrow Stem Cells Transplantation in a Premature Ovarian Failure Case Report

Abstract

Background: Patients with premature ovarian failure (POF) exhibit a diminished ovarian reserve and hormonal dysfunction. Case presentation: We aimed to restore normal hormonal function and folliculogenesis in a 31-year-old patient with POF, who had been amenorrheic for two years. We designed and performed three different ovarian regeneration procedures for three consecutive years, from 2015 to 2017: 1) intraovarian injection of activated autologous platelet-rich plasma (PRP); 2) activated autologous PRP and bone marrow-derived stem cell injection into the ovaries (SEGO); 3) ovarian cortical tissue resection and fragmentation; and in vitro ovarian tissue activation with autologous PRP and bone marrow stem cell retransplantation into the ovaries (the SEGOVA). The patient exhibited no improvement following the PRP treatment. The patient regained regular menstrual cycles after the SEGO procedure, although no follicular growth was observed yet. One month after the SEGOVA procedure, follicular growth was detected, and the patient underwent several stimulation protocols without obtaining oocytes. Eight months after the SEGOVA, the patient underwent in vitro fertilization (IVF) in a spontaneous cycle, when an oocyte of good quality was retrieved. Following intracytoplasmic sperm injection (ICSI), the oocyte failed to be fertilized. Eleven months after the SEGOVA, the patient reported a spontaneous pregnancy via natural conception. Pregnancy resulted in birth at term by uncomplicated vaginal delivery. After three different ovarian rejuvenation procedures, normal hormonal function and follicular growth were restored in the patient with POF, and the patient had a successful natural pregnancy following the last SEGOVA procedure. Although no ovarian function was detected after the first two procedures, they may have contributed to the outcomes from the SEGOVA procedure, a treatment that showed promising results in recovering ovarian function in patients with POF. Conclusions: It cannot be ruled out that ovarian rejuvenation with bone marrow‑derived stem cells and autologous growth factors, together with ovarian tissue fragmentation, took time to exhibit its effects and contributed to the final result – a successful natural conception and pregnancy.