We aimed to determine whether intraovarian injection of autologous platelet rich plasma (PRP) improves response to ovarian stimulation and in vitro fertilization (IVF) outcome in women with primary ovarian insufficiency (POI). Women (N=311; age 24-40) diagnosed with POI based on ESHRE criteria underwent intraovarian PRP injection. Markers of ovarian reserve, and IVF outcome parameters were followed. PRP treatment resulted in increased antral follicle count (AFC) and serum antimullerian hormone (AMH), while serum follicle stimulating hormone (FSH) did not change significantly. After PRP injection, 23 women (7.4%) conceived spontaneously, 201 (64.8%) developed antral follicle(s) and attempted IVF, and 87 (27.8%) had no antral follicles and therefore did not receive additional treatment. Among the 201 women who attempted IVF, 82 (26.4% of total) developed embryos; 25 of these women preferred to cryopreserve embryos for transfer at a later stage, while 57 underwent embryo transfer resulting in 13 pregnancies (22.8% per transfer, 4% of total). In total, of the 311 women treated with PRP, 25 (8.0%) achieved livebirth/sustained implantation (spontaneously or after IVF), while another 25 (8.0%) cryopreserved embryos. Our findings suggest that in women with POI, intraovarian injection of autologous PRP might be considered as an alternative experimental treatment option.

The aim of the current study was to characterize ovarian reserve parameters and IVF outcomes in women with a history of poor ovarian response (POR) treated with intraovarian injection of autologous platelet rich plasma (PRP). Reproductive age women (N=510; age range 30-45yo) diagnosed with POR based on Poseidon criteria were included in the study. PRP treatment resulted in higher AFC, higher serum AMH, lower serum FSH, and a higher number of mature oocytes and cleavage and blastocyst stage embryos. After PRP injection, 22 women (4.3%) conceived spontaneously, 14 (2.7%) were lost to follow up, and 474 (92.9%) attempted IVF. Among women who attempted IVF, 312 (65.8%) generated embryos and underwent embryo transfer, 83 (17.5%) achieved a pregnancy, and 54 (11.4%) achieved sustained implantation/live birth (SI/LB). In total, of the 510 women with POR and mean age of 40.3, PRP resulted in improvement of ovarian reserve parameters, a pregnancy rate of 20.5% and SI/LB rate of 12.9%. Our findings suggest that PRP treatment may be considered in women with POR. For wider clinical application, its clinical efficacy will need to be demonstrated in prospective randomized clinical trials.

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Oocyte donors present frequently a profile related to suboptimal responses to the ovulation induction with GnRH agonist due to hypothalamic suppression. Previous studies analyzed prognostic factors of GnRH antagonist protocol trigger with GnRH agonist (GnRHa). However, no data are available related to cycle outcomes with progestins (PPOS). Our objective is to evaluate predictors of ovarian response in oocyte donation (OD) cycles conducted in follicular phase with medroxyprogesterone acetate (MPA) and rFSH without rLH supplementation and agonist trigger.DESIGN: Non inferiority prospective RCT study. EudraCT number 2017-002341-30 and ClinicalTrials.gov registration number is 2017-002341-30 MATERIALS AND METHODS: University-affiliated infertility clinic. Period included from October 2017 to June 2019, to evaluate ovarian response in terms of number of oocytes and determine prognostic factors related to suboptimal response to GnRHa trigger in PPOS. We randomized 318 donors in two groups in a 1:1 ratio. In MPA group 161 participants received intervention (10 mg daily administered orally during OS) and 156 were treated with GnRH antagonist (started once the leading follicle had reached 13 mm). Some donors were pre-treated with oral contraceptives.Transvaginal ultrasound for follicular growth monitoring and serum extractions for analysis of estradiol (E2), LH, and progesterone (P) were performed on days of starting ovarian stimulation, 5, 7, 9 of stimulation and on the day of triptorelin administration.RESULTS: No significant differences were observed in donor demographic characteristics. For basal levels, we did not observe statistical differences for any of the hormones evaluated, regardless of contraceptive intake.On trigger day estradiol levels were significantly higher in the group treated with MPA (3363 pg/ml vs. 1330 pg/ml, p¼0.011) in donors who were not taking oral contraceptives. LH levels were significantly higher in the MPA group, both in presence (1.5 IU vs. 1.0 IU, p<0.001) and in absence (1.8 IU vs. 1.2 IU, p<0.001) of oral contraceptives. Percentage of donors who developed early luteinization was similar between groups, regardless donors were taking contraceptives or not.Basal progesterone level (p¼0.031) and LH triggering (p¼0.027) determination were negatively correlated with the number of oocytes retrieved during retrieval, while estradiol (<0.001) and progesterone (p¼0.026) heights the day of ovulation induction were positively associated with the same main outcome. Oral contraceptive administration and age did not significantly affect ovarian response CONCLUSIONS: Our findings support determination of basal P and E2, P and LH on trigger day in OD cycles stimulated with rFSH, MPA as co-treatment and trigger with GNRHa in order to identify women with a lower response in terms of number of oocytes.

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