Effects of intraovarian injection of autologous platelet rich plasma on ovarian reserve and IVF outcome parameters in women with primary ovarian insufficiency

Abstract

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.

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

“…Again in the study by Cakiroglu et al [ 19 ], the average of pretreatment and post-treatment values of antral follicle count were found to be 0.5 ± 0.5 and 1.7 ± 1.4 indicating a statistically significant increase (p-value= <0.01).…”

“…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 ].…”

“…In the study by Cakiroglu et al, the average of pretreatment and post-treatment values of serum FSH (all values in mIU/ml) were found to be 41.9 ± 24.7 and 41.6 ± 24.7 [ 19 ]. But this decrease in serum FSH levels was not statistically significant (p-value=0.87).…”

“…In the study by Cakiroglu et al, ART was attempted in 201 women who had at least one antral follicle after PRP out of which oocyte retrieval was performed in 130 (64.7% were stimulated) women [ 19 ]. Out of this, in 82 women (40.8% of stimulated cycles), at least one cleavage-stage embryo was obtained and embryo cryopreservation or fresh embryo transfer was performed.…”

“…A study by Cakiroglu et al found that women who did not have an antral follicle at the time of PRP injection were less likely to respond to treatment as compared to those who had one or two antral follicles [ 19 ]. Similarly, women with the lowest quartile for serum AMH and the highest for serum FSH were less likely to respond.…”