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Éliás M, Kónya M, Kekk Z, Turan C, das Virgens IPA, Tóth R, Keszthelyi M, Hegyi P, Várbíró S, Sipos M. Platelet-rich plasma (PRP) treatment of the ovaries significantly improves fertility parameters and reproductive outcomes in diminished ovarian reserve patients: a systematic review and meta-analysis. J Ovarian Res 2024; 17:104. [PMID: 38760869 PMCID: PMC11100055 DOI: 10.1186/s13048-024-01423-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 04/21/2024] [Indexed: 05/19/2024] Open
Abstract
INTRODUCTION The incidence of infertility caused by diminished ovarian reserve has become a significant problem worldwide. The beneficial effect of PRP treatment of the ovaries has already been described, but the high-level evidence of its effectiveness has not yet been proven. MATERIALS AND METHODS A systematic search was performed in five databases, until March 12th, 2024. Both randomized and non-randomized studies that compared PRP treatment of the ovaries to self-control among women with diminished ovarian reserve were eligible for inclusion. Hormonal levels (Anti-Müllerian hormone (AMH), Follicle stimulating hormone (FSH), Luteinizing hormone (LH), Estradiol (E2), In-vitro fertilization parameters (Antral follicle count, oocyte, and embryo count), biochemical and spontaneous pregnancy and livebirth were measured. RESULTS 38 eligible studies were identified reporting on 2256 women. The level of AMH rised, the level of FSH decreased significantly after the PRP treatment. AMH 1 month MD 0.20 (n = 856, p > 0.001, 95% CI: [0.12;0.28]), 2 months MD 0.26 (n = 910, p = 0.013, 95% CI: [0.07;0.44]), 3 months MD 0.36 (n = 881, p = 0.002,95% CI: [0.20;0.52]). FSH 1 month MD -10.20 (n = 796, p > 0.039, 95% CI: [-19.80;-0.61]), 2 months MD -7.02 (n = 910, p = 0.017, 95% CI: [-12.48; -1.57]), 3 months MD -8.87 (n = 809, p = 0.010, 95% CI: [-14.19; -3.55]). The antral follicle count elevated significantly MD 1.60 (n = 1418, p = < 0.001, 95% CI: [0.92; 2.27]). Significant improvement was observed in the number of retrieved oocytes MD 0.81 (n = 802, p = 0.002, 95% CI: [0.36; 1.26]), and embryos created MD 0.91 (n = 616, p = 0.001, 95% CI: [0.45;1.36]). The incidence of spontaneous pregnancy following PRP treatment showed a rate with a proportion of 0.07 (n = 1370, 95% CI: 0.04-0.12), the rate of biochemical pregnancy was 0.18 (n = 1800, 95% CI: 0.15-0.22), livebirth was 0.11 (n = 1482, 95% CI: 0.07-0.15). CONCLUSIONS Our meta-analysis showed that based on protocolized analysis of the widest scientific literature search to date, containing predominantly observational studies, PRP treatment resulted in a statistically significant improvement in the main fertility parameters of diminished ovarian reserve women. Further multicenter, randomized trials, with large patient numbers and a longer follow-up period are needed to certify our results and develop the most effective treatment protocol.
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Affiliation(s)
- Máté Éliás
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Márton Kónya
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Zsófia Kekk
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Caner Turan
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | | | - Réka Tóth
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Márton Keszthelyi
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Péter Hegyi
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Division of Pancreatic Diseases, Semmelweis University, Budapest, Hungary
- Institute for Translational Medicine, University of Pécs, Pécs, Hungary
| | - Szabolcs Várbíró
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Miklós Sipos
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.
- Center of Assisted Reproduction, Semmelweis University, Budapest, Hungary.
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Wang X, Li J, Lu W, Gao F, Zhang S, Li J. Therapeutic roles of platelet-rich plasma to restore female reproductive and endocrine dysfunction. Front Endocrinol (Lausanne) 2024; 15:1374382. [PMID: 38654928 PMCID: PMC11035829 DOI: 10.3389/fendo.2024.1374382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 03/27/2024] [Indexed: 04/26/2024] Open
Abstract
Millions of women worldwide are infertile due to gynecological disorders, including premature ovarian insufficiency, polycystic ovary syndrome, Asherman syndrome, endometrial atrophy, and fallopian tube obstruction. These conditions frequently lead to infertility and have a substantial impact on the quality of life of the affected couples, primarily because of their psychological implications and high financial costs. Recently, using platelets to stimulate cell proliferation and tissue differentiation has emerged as a promising approach in regenerative medicine. Platelet-rich plasma (PRP) shows considerable potential for promoting endometrial hypertrophy and follicle development, making it a promising therapeutic option for tissue repair or replacement. This review provides an overview of the recent advancements and underlying mechanisms of PRP therapy for various female reproductive diseases and presents new therapeutic options for addressing female infertility.
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Affiliation(s)
- Xiaoning Wang
- Department of Blood Transfusion, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Jin Li
- Department of Blood Transfusion, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Weiwei Lu
- Department of Blood Transfusion, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Fangbo Gao
- Department of Blood Transfusion, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Songling Zhang
- Department of Gynecologic Oncology, Gynecology and Obstetrics Centre, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Jiajia Li
- Department of Gynecologic Oncology, Gynecology and Obstetrics Centre, The First Hospital of Jilin University, Changchun, Jilin, China
- The Laboratory of Cancer Precision Medicine, The First Hospital of Jilin University, Changchun, Jilin, China
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Mahajan S, Choudhary N, Shrivastava J, Nawale N, More A. Enhancing Fertility: A Case Report of the Frozen Platelet-Rich Plasma Therapy for Thin Endometrium and Poor Ovarian Reserve. Cureus 2024; 16:e59271. [PMID: 38817504 PMCID: PMC11137608 DOI: 10.7759/cureus.59271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 04/29/2024] [Indexed: 06/01/2024] Open
Abstract
A 33-year-old female patient was assessed for primary infertility due to thin endometrium and poor ovarian reserve (POR). The effectiveness of platelet-rich plasma (PRP) therapy was evaluated in terms of thickening the endometrium and enhancing implantation. The patient also had a history of four intrauterine inseminations and one intracytoplasmic sperm injection (ICSI), along with low anti-Müllerian hormone (AMH) and high follicle-stimulating hormone levels which showed POR. Gonadotropins are given to enhance follicular growth, while agonists and antagonists are given to prevent premature luteinizing hormone surge and suppress the top axis. During the first oocyte pick-up (OPU), five oocytes were retrieved. ICSI was done to make fertilization easier. On day 5, the embryos had degraded from their initial high quality. The patient was advised to undergo treatment with PRP. The endometrial thickness was significantly thicker, raising the chance of implantation. The second OPU was scheduled, resulting in the retrieval of 14 oocytes on the same day ICSI was performed. High-quality blastocysts (4AA) were produced and transferred during embryo transfer, and the patient tolerated the procedure well. The clinical success of the pregnancy outcome was confirmed by another beta-human chorionic gonadotropin test.
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Affiliation(s)
- Sanket Mahajan
- Clinical Embryology, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Namrata Choudhary
- Clinical Embryology, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Jarul Shrivastava
- Clinical Embryology, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Neha Nawale
- Clinical Embryology, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Akash More
- Clinical Embryology, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Maged AM, Mohsen RA, Salah N, Ragab WS. The value of intraovarian autologous platelet rich plasma in women with poor ovarian reserve or ovarian insufficiency: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2024; 24:85. [PMID: 38280991 PMCID: PMC10821562 DOI: 10.1186/s12884-024-06251-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 01/03/2024] [Indexed: 01/29/2024] Open
Abstract
OBJECTIVES To assess the value of intraovarian PRP in women with low ovarian reserve. SEARCH STRATEGY Screening of databases from inception to January 2023 using the keywords related to "Platelet-rich plasma" AND "poor ovarian reserve" OR "ovarian failure". SELECTION CRITERIA Fourteen studies (1632 participants) were included, 10 included women with POR, 1 included women with POI and 3 included both POR and POI women. DATA COLLECTION AND ANALYSIS Extracted data included study settings, design, sample size, population characteristics, volume, timing and preparation of PRP administration, and outcome parameters. MAIN RESULTS AMH level was evaluated in 11 studies (2099 women). The mean difference (MD) was 0.09 with 95% CI of - 0.06, 0.24 (P = 0.25). Antral follicular count level was assessed in 6 studies (1399 women). The MD was 1.73 with 95% CI of 0.81, 2.66 (P < 0.001). The number of oocytes retrieved was evaluated in 7 studies (1413 women). The MD was 1.21 with 95% CI of 0.48, 1.94 (P = 0.001). CONCLUSION This systematic review found a significant improvement of AFC, the number of retrieved oocytes, the number of cleavage embryos and the cancellation rate in women with POR. TRIAL REGISTRATION Registration number CRD42022365682.
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Affiliation(s)
- Ahmed M Maged
- Department of Obstetrics and Gynecology, Kasr Al-Ainy Hospital, Cairo University, Cairo, Egypt.
| | - Reham A Mohsen
- Department of Obstetrics and Gynecology, Kasr Al-Ainy Hospital, Cairo University, Cairo, Egypt
| | - Noha Salah
- Department of Obstetrics and Gynecology, Kasr Al-Ainy Hospital, Cairo University, Cairo, Egypt
| | - Wael S Ragab
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fayoum University, Fayoum, Egypt
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Safarova S, Cevher Akdulum MF, Guler I, Bozkurt N, Erdem A, Karabacak RO. Does Platelet-Rich Plasma Treatment Increase In Vitro Fertilization (IVF) Success in the Infertile Population? Cureus 2023; 15:e47239. [PMID: 38021895 PMCID: PMC10654450 DOI: 10.7759/cureus.47239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
OBJECTIVES Platelet-rich plasma (PRP) is obtained by centrifuging the platelet-rich portion of the patient's own blood. The objective of our study is to retrospectively examine the impact of intraovarian PRP injection on infertile women with diminished ovarian reserve, specifically focusing on the oocyte count, oocyte quality, and endometrial thinning. METHODS A retrospective assessment was conducted on cases who had intraovarian PRP injection at the in vitro fertilization (IVF) unit of the Obstetrics and Gynecology Department of Gazi University School of Medicine hospital. The review encompasses the period from 1 January 2015 to 30 June 2020. The endometrial thickness, follicle count of greater than 14 millimeters, estradiol levels, follicle-stimulating hormone (FSH) levels, and antral follicle count were assessed during the menstrual cycle both prior to and within a period of 1-6 months following the PRP procedure. Twenty nonpregnant patients who had IVF before and 4-6 months after PRP were admitted to the post-PRP IVF cycle. The quantification of oocytes and M2 oocytes was conducted both prior to and subsequent to PRP treatment. RESULTS Among 120 cases, only 60 cases who fulfilled inclusion criteria were analyzed. The basal endometrial thickness, basal follicle number (>14 mm), estradiol value, oocyte count, and M2 oocyte count exhibited a statistically significant increase following the administration of PRP injection (p<0.001). The basal FSH value exhibited a notable drop following the administration of PRP injection, with a statistically significant difference (p=0.002). In the pregnant group, the number of oocytes obtained with oocyte pick-up (OPU) increased by 300%, and in the nonpregnant group, the increase was 125% only. The number of M2 oocytes obtained with OPU increased by 250% in the pregnant group, while it was 93% in the nonpregnant group. CONCLUSION Ultimately, the affordability of PRP production and its considerable theoretical efficacy have the potential to substantially decrease the expenses associated with assisted reproductive technology procedures. In the present scenario, the administration of an intraovarian PRP injection may be contemplated as a therapeutic intervention for women exhibiting diminished ovarian reserve.
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Affiliation(s)
| | | | - Ismail Guler
- Obstetrics and Gynaecology, Gazi University, Ankara, TUR
| | - Nuray Bozkurt
- Obstetrics and Gynaecology, Gazi University, Ankara, TUR
| | - Ahmet Erdem
- Obstetrics and Gynaecology, Gazi University, Ankara, TUR
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Sadullayev A, Medvediev M. Comparison of the effect on the ovarian reserve of modern methods of treatment of endometrioid cysts. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2022; 44:908-914. [PMID: 35483582 DOI: 10.1016/j.jogc.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 04/12/2022] [Accepted: 04/13/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To compare the efficacy and safety of autologous platelet-rich plasma (PRP) therapy in laparoscopy and transvaginal sclerotherapy for the treatment of endometrioid cysts for maintaining ovarian reserve. METHODS The study included 71 women under age 35 years with primary and secondary infertility. Twenty women underwent sclerotherapy of endometrioid cysts followed by autologous PRP injection into ovarian tissue, and 21 underwent laparoscopic cyst removal by stripping followed by autologous PRP injection. The control group consisted of 30 women who underwent laparoscopic cystectomy by stripping without autologous PRP injection. We assessed ovarian reserve for all patients before surgery as well 3 and 6 months after surgery by measuring serum anti-Müllerian hormone (AMH) levels and calculating antral follicle count using ultrasound. RESULTS In the control group, AMH levels had decreased significantly at 3 and 6 months post-surgery, whereas levels in laparoscopy and PRP group remained almost unchanged from initial levels. In the sclerotherapy group, we observed a tendency towards increased AMH levels, but it was not statistically significant when compared with initial results. Follicle count changes were similar to AMH patterns. CONCLUSION In this study, sclerotherapy in combination with PRP therapy for ovarian endometriomas was associated with improved measures of ovarian reserve, and the combination of laparoscopic excision of the endometrioma with PRP therapy facilitated ovarian reserve preservation.
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Affiliation(s)
- Asad Sadullayev
- Department of Obstetrics and Gynecology, Dnipro state medical university, Dnipro, Ukraine, 49044
| | - Mykhailo Medvediev
- Professor, Department of Obstetrics and Gynecology, Dnipro state medical university, Dnipro, Ukraine, 49044.
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Cakiroglu Y, Yuceturk A, Karaosmanoglu O, Kopuk SY, Korun ZEU, Herlihy N, Scott RT, Tiras B, Seli E. Ovarian reserve parameters and IVF outcomes in 510 women with poor ovarian response (POR) treated with intraovarian injection of autologous platelet rich plasma (PRP). Aging (Albany NY) 2022; 14:2513-2523. [PMID: 35320118 PMCID: PMC9004561 DOI: 10.18632/aging.203972] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 01/28/2022] [Indexed: 05/27/2023]
Abstract
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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Affiliation(s)
- Yigit Cakiroglu
- Acibadem Maslak Hospital Assisted Reproductive Technologies Unit, Sariyer, Istanbul, Turkey
- Acibadem Mehmet Ali Aydinlar University, Department of Obstetrics and Gynecology, Sariyer, Istanbul, Turkey
| | - Aysen Yuceturk
- Acibadem Maslak Hospital Assisted Reproductive Technologies Unit, Sariyer, Istanbul, Turkey
| | - Ozge Karaosmanoglu
- Acibadem Maslak Hospital Assisted Reproductive Technologies Unit, Sariyer, Istanbul, Turkey
| | - Sule Yildirim Kopuk
- Acibadem Maslak Hospital Assisted Reproductive Technologies Unit, Sariyer, Istanbul, Turkey
| | - Zeynep Ece Utkan Korun
- Acibadem Maslak Hospital Assisted Reproductive Technologies Unit, Sariyer, Istanbul, Turkey
| | - Nola Herlihy
- IVI RMA New Jersey, Basking Ridge, NJ 07920, USA
- Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Richard T. Scott
- IVI RMA New Jersey, Basking Ridge, NJ 07920, USA
- Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Bulent Tiras
- Acibadem Maslak Hospital Assisted Reproductive Technologies Unit, Sariyer, Istanbul, Turkey
- Acibadem Mehmet Ali Aydinlar University, Department of Obstetrics and Gynecology, Sariyer, Istanbul, Turkey
| | - Emre Seli
- IVI RMA New Jersey, Basking Ridge, NJ 07920, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT 06510, USA
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Zhang QL, Lei YL, Deng Y, Ma RL, Ding XS, Xue W, Sun AJ. Treatment Progress in Diminished Ovarian Reserve: Western and Chinese Medicine. Chin J Integr Med 2022; 29:361-367. [PMID: 35015221 DOI: 10.1007/s11655-021-3353-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2021] [Indexed: 11/03/2022]
Abstract
Diminished ovarian reserve (DOR), generally defined as a decreased number or quality of oocytes, has a significant impact on quality of life and fertility in women. In recent years, the incidence of DOR has been increasing and the ages of patients are younger. The search for an effective DOR treatment has emerged as one of the preeminent research topics in reproductive health. An effective DOR therapy would improve ovarian function, fertility, and quality of life in patients. In this review we evaluated DOR treatment progress both in Western medicine and Chinese medicine, and elucidated the characteristics of each treatment.
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Affiliation(s)
- Qiao-Li Zhang
- Department of Human Reproductive Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, 100026, China
| | - Ya-Ling Lei
- Department of Encephalopathy, Shaanxi Provincial Hospital of Chinese Medicine, Xi'an, 710000, China
| | - Yan Deng
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Rui-Lin Ma
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Xue-Song Ding
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Wei Xue
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Ai-Jun Sun
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China.
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Sabouni R, Tarrab R, Kalaji D, Abbassi H. A new approach of using platelet-rich autologous plasma to increase the ovarian reservoir in a Syrian patient with ovarian insufficiency: A case report. Ann Med Surg (Lond) 2022; 73:103149. [PMID: 34976384 PMCID: PMC8683667 DOI: 10.1016/j.amsu.2021.103149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/02/2021] [Accepted: 12/02/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction The prevalence of Primary ovarian insufficiency (POI) is estimated to be 1–2%, resulting from many causes, including, iatrogenic causes which are becoming more common. There is no precise treatment to restore fertility in POI patients. However, new treatments -such as ovarian rejuvenation using platelet-rich autologous plasma (PRP)- are being tested and have shown promising results. We report using a new PRP injection protocol to manage a Syrian patient with ovarian insufficiency. Case presentation A 35-year-old woman with five years of primary infertility presented with decreased anti-mullerian hormone (AMH) after she underwent a laparoscopy one year ago. Where the AMH dropped from 1.07 to 0.39 ng/mL after it. She underwent an ovarian rejuvenation using PRP. Half mL of PRP was injected into every ovary, 2 mL were injected into the cervix, 7 mL intra-uterus, and 7 mL were injected intramuscularly to the patient's legs. Fifteen days following the operation, the patient's new AMH level was 0.94 ng/mL. The patient was placed on ovarian stimulation, and five days later the ultrasonography showed the development of six follicles in each ovary. Discussion Managing POI using ovarian rejuvenation is the best alternative treatment; When the donor eggs programs are not acceptable. The use of PRP in ovarian rejuvenation has been reported to be effective. Conclusion The use of PRP was beneficial in restoring fertility in a Syrian patient with ovarian insufficiency. Furthermore, the new PRP injection protocol was successful. However, more studies are needed to confirm this result. Primary ovarian insufficiency effect 1–2% of all women. It is a major problem in countries where donor eggs programs are not acceptable. Ovarian rejuvenation using platelet-rich plasma showed promising results. The combination of generalized and localized effects may enhance the outcomes.
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Affiliation(s)
- Rami Sabouni
- Faculty of Medicine, Damascus University, Damascus, Syria
| | - Rand Tarrab
- Faculty of Medicine, Damascus University, Damascus, Syria
| | - Dania Kalaji
- Department of Radiology, Faculty of Medicine, Damascus University, Damascus, Syria
| | - Haitham Abbassi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Damascus University, Syria
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Navali N, Sadeghi L, Farzadi L, Ghasemzadeh A, Hamdi K, Hakimi P, Niknafs B. Intraovarian Injection of Autologous Platelet-Rich Plasma Improves Therapeutic Approaches in The Patients with Poor Ovarian Response: A Before-After Study. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2022; 16:90-94. [PMID: 35639652 PMCID: PMC9108296 DOI: 10.22074/ijfs.2021.533576.1154] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 09/18/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Advanced age is associated with a decline in the natural oocytes, low oocyte yield, and also increases the assisted reproductive technology (ART) failure rate, and consequently resulted in a pregnancy rate decrease. Platelet-rich plasma (PRP) is one of the proposed therapeutic strategies for women with poor ovarian response (POR). Because of the autologous source of PRP, the lowest risks of disease transmission, immunogenic and allergic reactions have been expected. This study aimed to evaluate the single-dose intraovarian injection of autologous PRP in poor ovarian reserve. MATERIALS AND METHODS We conducted a clinical trial study in the Al-Zahra hospital and Milad Infertility Clinic, Tabriz, Iran (April and May, 2021). A total of thirty-five women with a POR and mean age 40.68 ± 0.34 enrolled in this study. After injection of autologous PRP into the ovaries, the number of oocytes, antral follicles, and level of estradiol, anti-Müllerian hormone (AMH), follicle-stimulating hormone (FSH), luteal hormone (LH), FSH/LH ratio also were evaluated while, these parameters were evaluated before PRP administration. RESULTS At the 2-month follow-up, women treated with PRP showed a significant elevation in the number of oocytes (3.68 ± 0.24, P=0.0043) and embryos (3.17 ± 0.14, P=0.0001), as well as in the estradiol levels (404.1 ± 16.76 vs. 237.7 ± 13.14, P=0.0003). CONCLUSION Single PRP injection is effective and might be a promising therapeutic approach in the patients with POR to conceive with their own oocytes, although further evidence is required to assess the influence of PRP on the live birth rate.
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Affiliation(s)
- Nazli Navali
- Women’s Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Leila Sadeghi
- Department of Obstetrics and Gynecology, Alzahra Hospital, Tabriz University of Medical Sciences, Tabriz, Iran ,P.O.Box: 5138663134Department of Obstetrics and GynecologyAlzahra HospitalTabriz University of Medical SciencesTabrizIran
| | - Laya Farzadi
- Women’s Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Aliyeh Ghasemzadeh
- Women’s Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Kobra Hamdi
- Women’s Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Parvin Hakimi
- Department of Obstetrics and Gynecology, Alzahra Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Behrouz Niknafs
- Department of Reproductive Biology, Faculty of Advanced Medical Sciences, Tabriz University of Medical Science, Tabriz, Iran
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Tülek F, Kahraman A. The effects of intra-ovarian autologous platelet rich plasma injection on IVF outcomes of poor responder women and women with premature ovarian insufficiency. J Turk Ger Gynecol Assoc 2021; 23:14-21. [PMID: 34866374 PMCID: PMC8907433 DOI: 10.4274/jtgga.galenos.2021.2021.0134] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: There are controversial results regarding the administrations of platelet rich plasma (PRP) to increase in-vitro fertilization (IVF) success rates in the current literature. The aim of this study was to evaluate the effects of intra-ovarian PRP injections on IVF outcomes of poor responder women and women with premature ovarian insufficiency (POI). Material and Methods: The medical history and outcome of women receiving intra-ovarian PRP injections performed in a single tertiary center between 2018 and 2021 was retrospectively reviewed. Results: In total 71 women were included, of whom 21 were diagnosed with POI according to European Society of Human Reproduction and Embryology criteria and 50 were poor responders according to Bologna criteria. Number of retrieved oocytes, number of 2 pronuclear embryos and number of cleavage stage embryos were significantly higher in poor responder women after PRP injections. However clinical pregnancy rates and live birth delivery rates were similar before and after PRP injections in poor responders. In women with POI, 8 embryos were obtained in cycles commenced after PRP injections but no clinical pregnancies were achieved in this group of patients. Conclusion: Intra-ovarian PRP injections do not appear to increase live birth rates or clinical pregnancy rates in poor responder women or in those with POI, in this cohort.
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Affiliation(s)
- Fırat Tülek
- Department of Midwifery, Üskudar University Faculty of Health Sciences, İstanbul, Turkey.,Department of Obstetrics and Gynecology, Memorial Atasehir Hospital, İstanbul, Turkey
| | - Alper Kahraman
- Department of Obstetrics and Gynecology, Haseki Training and Research Hospital, İstanbul, Turkey
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12
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Atkinson L, Martin F, Sturmey RG. Intraovarian injection of platelet-rich plasma in assisted reproduction: too much too soon? Hum Reprod 2021; 36:1737-1750. [PMID: 33963408 PMCID: PMC8366566 DOI: 10.1093/humrep/deab106] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 04/09/2021] [Indexed: 12/13/2022] Open
Abstract
The prospect of ovarian rejuvenation offers the tantalising prospect of treating age-related declines in fertility or in pathological conditions such as premature ovarian failure. The concept of ovarian rejuvenation was invigorated by the indication of the existence of oogonial stem cells (OSCs), which have been shown experimentally to have the ability to differentiate into functional follicles and generate oocytes; however, their clinical potential remains unknown. Furthermore, there is now growing interest in performing ovarian rejuvenation in situ. One proposed approach involves injecting the ovary with platelet rich plasma (PRP). PRP is a component of blood that remains after the in vitro removal of red and white blood cells. It contains blood platelets, tiny anucleate cells of the blood, which are responsible for forming athrombus to prevent bleeding. In addition, PRP contains an array of cytokines and growth factors, as well as a number of small molecules.The utility ofPRP has been investigatedin a range of regenerative medicine approaches and has been shown to induce differentiation of a range of cell types, presumably through the action of cytokines. A handful ofcasereports have described the use of PRP injections into the ovaryin the human, and while these clinical data report promising results, knowledge on the mechanisms and safety of PRP injections into the ovary remain limited.In this article, we summarise some of the physiological detail of platelets and PRP, before reviewing the existing emerging literature in this area. We then propose potential mechanisms by which PRP may be eliciting any effects before reflecting on some considerations for future studies in the area. Importantly, on the basis of our existing knowledge, we suggest that immediate use of PRP in clinical applications is perhaps premature and further fundamental and clinical research on the nature of ovarian insufficiency, as well as the mechanism by which PRP may act on the ovary, is needed to fully understand this promising development.
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Affiliation(s)
- Lloyd Atkinson
- Centre for Atherothrombosis and Metabolic Disease, Hull York Medical School, University of Hull, Hull, UK
| | - Francesca Martin
- Centre for Atherothrombosis and Metabolic Disease, Hull York Medical School, University of Hull, Hull, UK
| | - Roger G Sturmey
- Centre for Atherothrombosis and Metabolic Disease, Hull York Medical School, University of Hull, Hull, UK.,Division of Developmental Biology and Medicine, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, St Mary's Hospital, Manchester, UK
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13
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Jiao Z, Bukulmez O. Potential roles of experimental reproductive technologies in infertile women with diminished ovarian reserve. J Assist Reprod Genet 2021; 38:2507-2517. [PMID: 34100154 DOI: 10.1007/s10815-021-02246-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 05/25/2021] [Indexed: 12/24/2022] Open
Abstract
In assisted reproductive technology treatment, diminished ovarian reserve (DOR) is a condition of utmost clinical and scientific relevance because of its negative influence on patient outcomes. The current methods of infertility treatment may be unsuitable for many women with DOR, which support the need for development of additional approaches to achieve fertility restoration. Various techniques have been tried to improve the quality and increase the quantity of oocytes in DOR patients, including mitochondrial transfer, activation of primordial follicles, in vitro culture of follicles, and regeneration of oocytes from various stem cells. Herein, we review the science behind these experimental reproductive technologies and their potential use to date in clinical studies for infertility treatment in women with DOR.
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Affiliation(s)
- Zexu Jiao
- Division of Reproductive Endocrinology and Infertility, Fertility and Advanced Reproductive Medicine Assisted Reproductive Technologies Program, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Orhan Bukulmez
- Division of Reproductive Endocrinology and Infertility, Fertility and Advanced Reproductive Medicine Assisted Reproductive Technologies Program, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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14
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Kim EJ, Cho MJ. The Association between Assisted Reproduction Technology (ART) and Social Perception of Childbearing Deadline Ages: A Cross-Country Examination of Selected EU Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2111. [PMID: 33671523 PMCID: PMC7926318 DOI: 10.3390/ijerph18042111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/15/2021] [Accepted: 02/19/2021] [Indexed: 11/17/2022]
Abstract
The advancement of assisted reproductive technologies (ART) has gained much attention in relation to childbearing postponement. Our study's purpose was to empirically examine how perceptions of childbearing deadline age vary in association with availability and prevalence of ART across different countries. The present study used data from the 2006 European Social Survey and the 2006 European Society of Human Reproduction and Embryology to examine selected EU countries. A total sample of 17,487 respondents was examined. Multilevel regression modeling was used. Results showed that first, younger generations were more generous with maternal childbearing ages but stricter with paternal deadline ages. Second, respondents residing in countries with higher percentage of reproductive clinics per population were more generous with maternal ages, however no significant association was observed with regard to paternal childbearing ages. Third, on the contrary, respondents residing in countries with higher utilization of ART treatments were stricter with maternal ages, which may be because they are more likely to be aware of the physiological and financial difficulties associated with ART treatments. The present study is meaningful in that it is the first study to empirically examine social perceptions of childbearing ages in relation with ART.
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Affiliation(s)
- Eun Jung Kim
- School of Architecture, Hanyang University, Seoul 04763, Korea
| | - Min Jung Cho
- Faculty Governance and Global Affairs, Leiden University College, 2595 DG The Hague, The Netherlands
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