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Efficacy of intra-ovarian injection of autologous platelet-rich plasma in women with poor responders: a systematic review and meta-analysis

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Abstract

Context

The effect of platelet-rich plasma (PRP) on ovarian reserve markers in poor ovarian response (POR) is challenging.

Aim

This systematic review and meta-analysis was, therefore, designed to evaluate the effectiveness of intra-ovarian injection of autologous PRP on improving ovarian reserve markers and assisted reproductive technology (ART) outcomes in infertile women with POR.

Methods

A systematic search was conducted for the efficacy of intra-ovarian injection of autologous PRP on the improvement of ovarian reserve markers and ART outcomes in infertile women with POR. The methodological quality of the included studies was checked and eligible studies were included in the meta-analysis to find pooled results. Keywords were primary ovarian insufficiency, premature menopause, poor responder, poor ovarian response, diminished/decreased ovarian reserve, platelet-rich plasma, and intra-ovarian or a combination of them. The effect of PRP on fertility indices was evaluated using the standardized mean difference (SMD). The analysis was performed through STATA version 13.

Key results

13 studies containing 1289 patients were included. Mean age, body mass index (BMI) and duration of infertility was 37.63 ± 2.66 years, 24 ± 1.23 kg/m2 and 4.79 ± 1.64 years, respectively. Most of the studies measured the outcomes 2–3/3 months after intra-ovarian injection of autologous PRP. The antral follicular count (AFC) after treatment by PRP is higher with an SMD of 0.95 compared to before treatment. The day 3 follicle-stimulating hormone (FSH) after treatment by PRP is lower with an SMD of − 0.25 compared to before treatment. The day 3 estradiol (E2) after treatment by PRP is higher with an SMD of 0.17 compared to before treatment. The anti-Mullerian hormone (AMH) after treatment by PRP is higher with an SMD of 0.44 compared to before treatment. The total oocytes number after treatment by PRP is higher with an SMD of 0.73 compared to before treatment. The number of MII oocytes after treatment by PRP is higher with an SMD of 0.63 compared to before treatment. The number of cleavage-stage embryos after treatment by PRP is higher with an SMD of 1.31 compared to before treatment. The number of day 5 embryo after treatment by PRP is higher with an SMD of 1.28 compared to before treatment. Pooled estimation of a meta-analysis of prevalence studies reported a prevalence of 22% for clinical pregnancy, 5% for spontaneous pregnancy and 21% for ongoing pregnancy following PRP therapy.

Conclusion

Intra-ovarian injection of PRP improved ovarian reserve markers with increasing AFC, serum level of AMH and day 3 E2 and decreasing serum level of day 3 FSH. In addition, this treatment improved ART outcomes through the increasing of number total oocytes, number of MII oocytes, number of cleavage-stage embryos and number of day 5 embryos in POR women.

Implications

Although treatment of POR women remains challenging, the use of intra-ovarian injection of autologous PRP in POR patients prior to IVF/ICSI cycles is a sign of new hope for increasing the success of IVF/ICSI. However, further well-organized, randomized controlled trials should be conducted to substantiate this result and recommend intra-ovarian injection of PRP as part of routine treatment in women with POR.

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Data availability

The data of this study can be available on formal and reasonable request to corresponding author by email for academic works by faculty members.

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Funding

This work received no grant from any funding agency in the public, commercial, governmental, or academic sectors.

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Author notes

  1. Hossein Hosseinirad and Tahereh Doohandeh have contributed equally to this work.

Authors and Affiliations

  1. Avicenna Infertility Clinic, Avicenna Research Institute, ACECR, Tehran, Iran

    Mozhgan Vahabi Dastjerdi

  2. Department of Obstetrics and Gynecology, Preventive Gynecology Reproductive Medicine, School of Medicine, Preventative Gynecology Research Center, Shahid Beheshti University of Medical Sciences, Arabi Ave, Daneshjoo Blvd, Velenjak, Tehran, 1983969411, Iran

    Samaneh Sheibani & Tahereh Doohandeh

  3. Department of Biology, Science and Research Branch, Islamic Azad University, Tehran, Iran

    Maryam Taheri & Fouzieh Karami Hezarcheshmeh

  4. Department of Reproductive Biology, Faculty of Basic Sciences and Advanced Medical Technologies, Royan Institute, ACECR, Tehran, Iran

    Jamileh Jahangirian

  5. Department of Medical Biotechnology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

    Maryam Jazayeri

  6. Department of Obstetrics, Gynecology and Women’s Health, University of Missouri, Columbia, MO, USA

    Hossein Hosseinirad

  7. Urmia University of Medical Sciences, Urmia, Iran

    Rohollah Valizadeh

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  1. Mozhgan Vahabi Dastjerdi
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Contributions

MV, HH, RV, TD: concept and design; SS, MT, FKH: data screening; RV, JJ, MJ, HH: data analysis; all the authors contributed in manuscript draft; MV, SS, HH, RV and TD revised the final version.

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Correspondence to Hossein Hosseinirad or Tahereh Doohandeh.

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Vahabi Dastjerdi, M., Sheibani, S., Taheri, M. et al. Efficacy of intra-ovarian injection of autologous platelet-rich plasma in women with poor responders: a systematic review and meta-analysis. Arch Gynecol Obstet (2024). https://doi.org/10.1007/s00404-024-07442-0

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