The use of autologous platelet-rich plasma (PRP) versus no intervention in women with low ovarian reserve undergoing fertility treatment: a non-randomized interventional study

Abstract

Purpose To investigate the impact of a 3-month course of intracortical injections of autologous platelet-rich plasma (PRP) upon ovarian reserve markers versus no intervention in women with low ovarian reserve prior to undergoing assisted reproductive technology (ART). Methods Prospective controlled, non-randomized comparative study conducted in a private fertility clinic, in Venezuela. Women with abnormal ovarian reserve markers (FSH, AMH and AFC) who declined oocyte donation were allocated to one of the following groups according to patient choice: monthly intracortical ovarian PRP injections for three cycles, or no intervention. Primary outcomes were the change in FSH, AMH and AFC pre-and post-treatment. Secondary outcomes included the number of oocytes collected and fertilized, biochemical/clinical pregnancy rates and miscarriage and live birth rates. Results Eighty-three women were included, of which 46 received PRP treatment and 37 underwent no intervention. Overall median age was 41 years (IQR 39-44). There were no demographic differences between the study groups. At the 3-month follow-up, women treated with PRP experienced a significant improvement in FSH, AMH and AFC, whereas there was no change in the control group. Furthermore, overall rates of biochemical (26.1% versus 5.4%, P = 0.02) and clinical pregnancy (23.9% versus 5.4%, P = 0.03) were higher in the PRP group, while there was no difference in the rates of first trimester miscarriage and live birth between groups. Conclusion PRP injections are effective and safe to improve markers of low ovarian reserve prior to ART, although further evidence is required to evaluate the impact of PRP on pregnancy outcomes.

Reactivating Ovarian Function through Autologous Platelet-Rich Plasma Intraovarian Infusion: Pilot Data on Premature Ovarian Insufficiency, Perimenopausal, Menopausal, and Poor Responder Women

“…Interestingly, recent data demonstrated that PRP intraovarian infusion may improve ovarian reserve in POR patients of advanced age [60]. Melo and colleagues showed a significant improvement in AMH levels and AFC during the first three months of the follow-up period, while participants presented with a higher clinical pregnancy rate compared to the control group [60]. In our study, we report an overall clinical pregnancy rate of 46.6% following PRP treatment.…”

“…In our study, we report an overall clinical pregnancy rate of 46.6% following PRP treatment. Our participants were on average three years younger, and subjected to ICSI treatment on the third month following a single PRP treatment in contrast to the study of Melo et al, 2020 in which patients were subjected to ART treatment within a 12-month time-frame [60]. Considering results presented in the study of Melo et al, 2020 as well as in ours, it seems that PRP treatment may be effective in POR patients of both young and advanced age.…”

“…At this point it should be highlighted that the patients presented herein were young POR patients (mean age 38.40 years old) and thus the efficiency of PRP treatment in advanced age (>40 years old) POR patients cannot be accounted for in the present study. Interestingly, recent data demonstrated that PRP intraovarian infusion may improve ovarian reserve in POR patients of advanced age [60]. Melo and colleagues showed a significant improvement in AMH levels and AFC during the first three months of the follow-up period, while participants presented with a higher clinical pregnancy rate compared to the control group [60].…”

“…Considering results presented in the study of Melo et al, 2020 as well as in ours, it seems that PRP treatment may be effective in POR patients of both young and advanced age. However maternal age may strongly impact on final pregnancy outcomes [60].…”

“…Several other factors, potentially affecting treatment's outcome should be elucidated in future studies focusing on optimal protocol design. There are questions pertaining to the number of PRP infusions that constitute one treatment cycle, time intervals between infusions-especially if administrations are consecutive as in the case of Melo et al, 2020 [60], with optimal time-frame between PRP infusions and IVF/ICSI treatment, volume administered, as well as platelets' threshold. Future studies should follow a ''from bench to bedside" approach, to provide sufficient data investigating molecular and physiological mechanisms entailing the therapeutic value of PRP infusion in different types of ovarian insufficiency.…”