Resumed ovarian function and pregnancy in early menopausal women by whole dimension subcortical ovarian administration of platelet-rich plasma and gonadotropins

Abstract

Objective: This study was designed to investigate if whole dimension subcortical ovarian administration of platelet-rich plasma with gonadotropin, in proximity to most ovarian follicles, is effective in restoring ovarian functions in women during early menopause. Methods: Platelet-rich plasma, prepared from 40 mL of autologous peripheral blood using the buffy coat method, was injected into extended subcortical area of bilateral ovaries along with recombinant follicle-stimulating hormone (rFSH) (Gonal-F 300IU) under laparoscopic guidance. The posttreatment ovarian folliculogenesis and serum levels of FSH, luteinizing hormone (LH), and estradiol were followed up for 6 months at weekly to monthly intervals. IVF was carried out in women resuming ovulatory functions. Results: Twelve early menopausal women with mean age of 44.42 ± 2.84 were enrolled. After treatment, 11 women resumed their menstrual period in 37.1 ± 23.5 days. Their average serum FSH was 70.47 ± 20.92 and 26.22 ± 17.55 IU/L, luteinizing hormone was 34.81 ± 11.86 and 14.3 ± 12.8 IU/L, before and after treatment, respectively. The mid-cycle E2 was 251.1 ± 143.8 pg/mL. Ten oocyte retrievals were carried out among six participants, four of them received controlled ovarian stimulation and another two using natural ovulation cycles. Thirteen mature eggs were retrieved which were then ICSI fertilized to obtain 10 normally fertilized 2PN oocytes. Two participants had cleavage stage embryos transferred of which one achieved clinical pregnancy. Conclusions: Whole dimension subcortical ovarian administration of platelet-rich plasma with gonadotropin was shown to restore ovarian functions, at least temporarily, and could increase the probability of pregnancy using autologous oocytes in women with early menopause.

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 ].…”

Elevated gonadotropin levels are associated with increased biomarker risk of Alzheimer’s disease in midlife women

“…Initial studies show that serum FSH dramatically decreases after ovarian tissue transplantation, inducing the resumption of folliculogenesis in grafts 47,48 , thus possibly delaying the onset of menopause and associated neuropathological changes. Finally, the administration of plateletrich plasma with recombinant FSH to the ovaries was shown to restore ovarian function, at least temporarily, in early post-menopausal women 49 . While this technique is aimed at prolonging a woman's fertility period 49 , it may also hold promise for prevention of menopause-associated AD risk.…”

“…Finally, the administration of plateletrich plasma with recombinant FSH to the ovaries was shown to restore ovarian function, at least temporarily, in early post-menopausal women 49 . While this technique is aimed at prolonging a woman's fertility period 49 , it may also hold promise for prevention of menopause-associated AD risk.…”

Intraovarian Injection of Recombinant Human Follicle-Stimulating Hormone for Luteal-Phase Ovarian Stimulation during Oocyte Retrieval Is Effective in Women with Impending Ovarian Failure and Diminished Ovarian Reserve

“…In the era of increasing demand for more women, many with advanced age, with DOR/IOF request IVF treatments, different administration modes of rhFSH might optimize their response to COS. Our recent studies by administrating rhFSH in combination with PRP directly into the target ovarian tissue and also whole dimension subcortical ovarian administration indicated the restoration of ovarian function and clinical pregnancy in women with premature ovarian insufficiency and early menopause [ 15 , 16 ]. We have also demonstrated that both intradermally and intravaginally administered rhFSH can be absorbed efficiently and enhance ovarian follicle growth in POR women [ 17 , 19 , 29 , 30 , 31 ].…”

“…However, the efficacy of luteal-phase DuoStim in patients with DOR/IOF has not yet been examined. The enhancement of folliculogenesis has recently been shown in women with POI and early menopausal women who received intraovarian administration of rhFSH with platelet-rich plasma (PRP) [ 15 , 16 ]. We, therefore, hypothesized that more oocytes could be obtained by continuing ovarian stimulation after the first oocyte retrieval under direct ovarian administration of rhFSH.…”