Live Birth in Woman With Premature Ovarian Insufficiency Receiving Ovarian Administration of Platelet-Rich Plasma (PRP) in Combination With Gonadotropin: A Case Report

Abstract

The conception rates among women with premature ovarian insufficiency (POI) remain extremely low. To achieve a successful pregnancy, most of these women have to receive donor oocytes through IVF treatment. Ovarian administration of platelet-rich plasma (PRP) has been recently applied to enhance the ovulatory function in women with poor ovarian response. However, no live birth has been reported for this application in patients with POI. In this study, we present a 37-year-old woman with POI who had secondary amenorrhea for 6 months. The clinical manifestations and evaluation of this women with a diminished ovarian function were an undetectable serum level of AMH (<0.02 ng/mL) and an elevated serum level of FSH (63.65 mIU/mL). A single dose of autologous PRP (extracted from 40 mL of peripheral blood) in combination with gonadotropin (150IU rFSH/75 IU rLH) was directly injected into the stroma of bilateral ovaries via vaginal sonographic guidance. Following the treatment, this patient received controlled ovarian stimulation and IVF during the successive months. Following embryo culture, three cleavage-stage embryos were transferred, leading to a successful pregnancy, which later resulted in the live birth of twins. This case report provides one example of alternative therapy that allows POI patients to use autologous oocytes in IVF treatment.

Recent advances in understanding primary ovarian insufficiency

“…This PRP-based tissue regenerative approach has been attempted across several injured human tissue types (tendons, muscles, and nerves) with the goal of improved healing 55 primarily through the promotion of neoangiogenesis. In a case report, the use of PRP with direct gonadotropin intraovarian injection resulted in successful conception in a POI patient who subsequently achieved a live birth 56 .…”

“…Follicle growth was subsequently observed in eight patients and mature oocytes were retrieved from five patients; one woman achieved a live birth 78 . In light of the understanding of the Hippo signaling pathway and its relevance for ovarian follicular development, it is plausible to consider that any benefits of intraovarian PRP injection on ovarian physiology may be secondary to a modulation of the Hippo pathway from physical disruption of the ovarian tissue (from injection), and not from intraovarian growth factors, as is hypothesized 56 .…”

Ovarian Folliculogenesis and Uterine Endometrial Receptivity after Intermittent Vaginal Injection of Recombinant Human Follicle-Stimulating Hormone in Infertile Women Receiving In Vitro Fertilization and in Immature Female Rats

“…In the era of increasing demand for more efficient ovarian stimulation, as many advanced aged women and more women of poor ovarian reserve request IVF treatments, different administration modes of recombinant human FSH (rhFSH) might provide each patient an individualized tailored scheme to optimize the response of COS. Our recent studies proved that rhFSH can be administered intradermally and effectively absorbed and delivered to the ovaries to enhance the follicle growth [ 23 , 24 ]. The rhFSH in combination with platelet rich plasma has recently been directly injected into the target ovarian tissue and ovarian subcortical area to restore the ovarian function and achieve clinical pregnancy in women of premature ovarian insufficiency and early menopause [ 25 , 26 ].…”

Premature ovarian insufficiency: an International Menopause Society White Paper

“…Four pregnancies were reported after bone marrow or peripheral blood stem cell transplantation 140 and there are several mouse and rat models that have shown resumption of ovarian function after mesenchymal stem cell transfusion 141 . Platelet-rich plasma has been used for in vitro maturation of primordial and primary follicles 142 , and there is a case report of a live birth (of twins) following single intraovarian injection of platelet-rich plasma in combination with gonadotropin and followed by two cycles of ovarian stimulation delivered by intravaginal injection 143 .…”