Live Birth Rates in Poor Responders’ Group after Previous Treatment with Autologous Platelet-Rich Plasma and Low Dose Ovarian Stimulation Compared with Poor Responders Used Only Low Dose Ovarian Stimulation Before in Vitro Fertilization

Abstract

BACKGROUND: This prospective pilot study determined the efficacy of previous transvaginal intraovarian injection with autologous platelet-rich plasma (PRP) in poor ovarian responders (PORs) fulfilling the Bologna criteria before in vitro fertilisation (IVF)/intracytoplasmic sperm injection (ICSI) with low dose ovarian stimulation. Current knowledge of efficient treatment for PORs is limited and often contradictory; also, LBRs of IVF remains disappointingly low.
 AIM: We assessed the live birth rates (LBRs) in PORs after previous ovarian treatment with PRP.
 METHODS: Overall, 40 patients undergoing IVF/ICSI between June 2017 ending December 2018 were included. A transvaginal intraovarian injection of PRP was performed on 20 patients. Both compered groups were balanced for all basic characteristics, and multivariate analysis was performed to adjust for all known confounders.
 RESULTS: Between the groups, a statistical significance in clinical pregnancies and LBR was not found. Clinical pregnancy and live birth rates were 33.33 ± 44.99 and 40.00 ± 50.71 in the PRP group and 10.71 ± 28.95 and 14.29 ± 36.31 in control group retrospectively. However, there is a trend towards higher implantation rates and LBRs in patients with previous treatment with PRP. Anyhow, the number of patients used in the research is insufficient to make a concrete conclusion, and more studies are needed in the future to confirm these results entirely.
 CONCLUSION: Even though the treatment of POR responders remains as a therapeutical challenge, the usage of intraovarian injection of autologous PRP in PORs before the IVF performance brings a glimpse of new hope in increasing the success of IVF defined by clinical pregnancy and LBRs.

Intra-ovarian injection of platelet-rich plasma into ovarian tissue promoted rejuvenation in the rat model of premature ovarian insufficiency and restored ovulation rate via angiogenesis modulation

“…They reported that IP injection of PRP in POI rats increased the healthy primary and antral follicle counts, and they pointed out PRP as a protective agent against ovotoxic chemicals [31]. Along with the conduction of experiments involving intra-ovarian injection of PRP in animal models, some clinical trials have been started in human, opening hopes and therapeutic avenues in ovarian regeneration [32,33].…”

“…Talking about suitable clinical settings to administrate PRP, transvaginal ultrasound-guided injection is a good candidate, since it is a nonsurgical technique that allows the clinicians to inject biological products like cells/PRP directly into the ovarian tissue. This technique is performed under sedation and is basically the same method used for an egg aspiration/retrieval during IVF/ICSI operation [32,51]. As described above, stem cell transplantation is another putative therapeutic option for POI patients and potentially more powerful in combination with PRP; however, stem cell therapy is sometimes associated with tumorigenesis, making this approach less safe than others [52].…”

What Is the Best Regimen for Ovarian Stimulation of Poor Responders in ART/IVF?

“…In the last year a "glimpse of new hope" for POR-IVF patients has been suggested by two preliminary publications (112,113). In these reports, autologous platelet-rich plasma (PRP) was injected intraovarially by transvaginal sonographic guidance, before the IVF COH (112,113).…”

“…In the last year a "glimpse of new hope" for POR-IVF patients has been suggested by two preliminary publications (112,113). In these reports, autologous platelet-rich plasma (PRP) was injected intraovarially by transvaginal sonographic guidance, before the IVF COH (112,113). The preliminary results suggest a trend toward better implantation rates and LBRs in those POR patients who have received the intraovarian PRP injections (112,113).…”

“…In these reports, autologous platelet-rich plasma (PRP) was injected intraovarially by transvaginal sonographic guidance, before the IVF COH (112,113). The preliminary results suggest a trend toward better implantation rates and LBRs in those POR patients who have received the intraovarian PRP injections (112,113). Interestingly and encouraging, autologous FSH decreased and AMH increased following the PRP treatment (113).…”