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

Abstract

This registered, prospective clinical trial assessed serum anti-Mullerian hormone (AMH) patterns after treatment with activated platelet rich plasma (PRP). Patients with low ovarian reserve and/or at least 1 prior failed in vitro fertilization (IVF) cycle (n=182) received PRP injected into ovarian tissue under ultrasound guidance. Pretreatment AMH, BMI and platelet (PLT) concentration were recorded and serum AMH, follicle stimulating hormone, and estradiol were then measured at 2-week intervals for up to three months. Mean±SD patient age was 45.4±6.1yrs. Improved serum AMH was observed in 51 patients (28%) with median increase of 167% [95%CI 91; 280] after treatment; mean interval to maximum AMH increase was 4 weeks (range 2-10 weeks). Improved post-treatment AMH was not limited to younger patients; when stratified by age (<42 vs. ≥42yrs), significant AMH improvements were seen in both groups after treatment (p=0.03 and 0.009, respectively). Among responders, mean basal PLT count was higher (274K) vs. non-responders (250K); p<0.001. This is the first clinical trial to describe an intraovarian PRP technique for low reserve and finds the treatment safe and associated with significant increases in serum AMH for some patients, usually within four weeks. The substantially different pre-treatment PLT concentrations measured across PRP response groups warrants further investigation. Additional research can characterize ovarian response better, optimize PRP protocols, and collect outcomes data from those who subsequently undergo IVF with autologous oocytes.

A Systematic Review Evaluating the Efficacy of Intra-Ovarian Infusion of Autologous Platelet-Rich Plasma in Patients With Poor Ovarian Reserve or Ovarian Insufficiency

“…At the same time in the study by Cakiroglu et al [19] and Sills et al [22], the level of serum AMH was also found to be increased (Table 3) after intra-ovarian PRP infusion with a statistically significant difference (pvalues of <0.01 and 0.0016 for the respective studies). Sills et al [22] found platelet count as a parameter likely to predict AMH response to intra-ovarian PRP injection.…”

“…In this systematic review, we have included four studies that evaluated the effectiveness of PRP in infertile women diagnosed with decreased ovarian reserve or premature ovarian failure or menopause. Table 1 outlines the characteristics of all included studies [ 19 - 22 ].…”

“…Moreover, Sills et al found an increase in the post-treatment serum FSH value of 64.68 ± 5.5 from its pretreatment value of 52.67 ± 4.64 with a statistically significant difference (p-value<0.0001) [ 22 ].…”

“…After reading the full text of those 16 articles, 12 articles (three case series, two case reports, one article with insufficient data, one study involving in-vitro experimental design, and five review articles) were excluded. Finally, four studies were included in our systematic review [19][20][21][22]. The flow diagram of the literature search and selection of studies is shown in Figure 1.…”

“…In this systematic review, we have included four studies that evaluated the effectiveness of PRP in infertile women diagnosed with decreased ovarian reserve or premature ovarian failure or menopause. Table 1 outlines the characteristics of all included studies [19][20][21][22]. Out of four included studies, one was a non-randomized clinical trial and three were quasi-experimental studies (uncontrolled before and after studies).…”