Therapeutics Emerging Therapies

Intraovarian Platelet-rich Plasma Administration Induced Spontaneous Ovulation in an Anovulatory Woman With PCOS

Wang R, Merhi Z, Mouanness M, Seckin S

Published March 2023 JCEM Case Reports, 1(2), luad038
DOI 10.1210/jcemcr/luad038 PMID 37908477 PMC PMC10580434

RRM Academy Synopsis

Ovulation followed an ovarian PRP injection in one woman with PCOS

A single case report describes a woman with PCOS (also called PMOS, polyendocrine metabolic ovarian syndrome) who ovulated after platelet-rich plasma (PRP) was injected into her ovaries. She was 35 and at times had gone more than a year without a period. Her testosterone fell afterward, and no pregnancy was reported.

Key Findings

  • Before the injection, ultrasound counted over 15 antral follicles in each of her enlarged ovaries, and her total testosterone was above the reference range.
  • Ten days after the injection, a dominant follicle measured 14.5 mm in the right ovary. Three days later it measured 17.5 mm.
  • A visit four days later confirmed ovulation through a raised progesterone level and a corpus luteum on ultrasound. A pregnancy test two weeks after the presumed ovulation day was negative.
  • Four weeks after the injection, her total testosterone was within the reference range.
  • In a second monitored cycle, an 18 mm follicle grew in the left ovary by cycle day 19. After a trigger injection and insemination, she reported a period two weeks later.

Interpretation

This case report followed one woman with PCOS whose ovulation returned after an ovarian PRP injection, confirmed by a rise in progesterone and a corpus luteum on ultrasound. The authors note that the needle injection itself may have contributed to the response, similar to effects seen with ovarian drilling. The findings support larger studies of this approach.

RRM Context

A 2026 international consensus published in The Lancet renamed PCOS polyendocrine metabolic ovarian syndrome (PMOS). The authors note that drugs targeting ovulation do not treat what causes the problem. Restorative reproductive medicine starts from that question: why is this woman not ovulating? It seeks the cause in each woman and aims to restore her own cycle. Here, ultrasound and a progesterone test showed that ovulation happened.

Abstract

The use of platelet-rich plasma (PRP) has become popular as an adjunct to fertility treatment for women with infertility, particularly those with low ovarian reserve and premature ovarian insufficiency. Recent data in a polycystic ovary syndrome (PCOS) animal model demonstrated that intraovarian PRP administration improved folliculogenesis, ovarian antioxidant potential, and serum hormonal imbalance, suggesting that PRP could be considered a novel technique to alleviate PCOS-induced pathogenesis. With injection of PRP into the ovaries, it has been hypothesized that the infusion of cytokines and growth factors may exhibit a local effect that changes the expression of genes important in folliculogenesis and steroidogenesis, decreases inflammation, and partially restores normal ovarian function. This report is the first to present a case of a long-term amenorrheic woman with PCOS who has been trying to conceive, who resumed spontaneous ovulatory cycles, and had improvement in several aspects of her hormonal imbalance following intraovarian PRP administration. The purpose of this case report is to increase awareness regarding the possible benefits of intraovarian PRP injections for women with PCOS. There is a clear need for larger prospective studies to properly elucidate the effect of intraovarian PRP administration on both the reproductive and metabolic dysfunctions observed in women with PCOS.

Topics

By this author

Related research

Therapeutics › Emerging Therapies › Platelet-Rich Plasma · Menstrual Cycle › Cycle Disorders › Ovulatory Disturbances · Infertility › Ovulation Induction › Gonadotropin Therapy
Marco Mouanness, Ruoyu Wang, Zaher Merhi, Serin Seckin
M Mouanness, R Wang, Z Merhi, S Seckin
PMID 37908477 37908477 DOI 10.1210/jcemcr/luad038 10.1210/jcemcr/luad038 Wang et al. 2023, Wang 2023