Intraovarian Platelet-Rich Plasma Injections: Safety and Thoughts on Efficacy  Based on a Single Centre Experience With 469 Women

Mattheos Fraidakis; Giorgios Giannakakis; Aliki Anifantaki; Meltini Skouradaki; Paraskevi Tsakoumi; Popi Bitzopoulou; Sofia Kourpa; Alexandros Zervakis; Persefoni Kakouri

doi:10.7759/cureus.38674

Assisted Reproduction Add-Ons and Adjuncts

Intraovarian Platelet-Rich Plasma Injections: Safety and Thoughts on Efficacy Based on a Single Centre Experience With 469 Women

Fraidakis M, Giannakakis G, Anifantaki A, Skouradaki M, Tsakoumi P, Bitzopoulou P, Kourpa S, Zervakis A, Kakouri P

Published May 2023 Cureus, 15(5), e38674

DOI 10.7759/cureus.38674 PMID 37288228 PMC PMC10243509

RRM Academy Synopsis

FSH levels fell after ovarian PRP injections in 469 women

FSH levels fell after platelet-rich plasma was injected into the ovaries, in every age group studied, in a study of 469 women at one Greek IVF clinic. FSH (follicle-stimulating hormone) was measured before treatment and again at three and four months. The authors reported no side effects.

Key Findings

The study analyzed 469 of the 3,480 women treated with platelet-rich plasma between January 2019 and February 2022 (13.5%). Average age at the start of therapy was 41.9±4.3 years.
FSH concentration was significantly reduced after the injection in the 32 to 37, 38 to 42 and 43 to 46 year age groups (p < 0.001 in each).
Among women aged 32 to 37, the number with a normal FSH value rose from 8 to 51, and with normal estradiol from 13 to 71 (p < 0.001 each).
Estradiol concentration showed no significant difference across the three time points in the 32 to 37, 38 to 42 and 43 to 46 year groups (p = 0.267, 0.537, 0.380).
No patient reported an adverse side effect, according to the authors.

Interpretation

This cohort study followed 469 women who had platelet-rich plasma injected into their ovaries at a private IVF clinic in Greece. The women had a history of infertility, hormone problems, absent periods, or early ovarian failure. FSH levels fell in all three age groups studied. Estradiol levels stayed about the same. No patient reported a side effect. The authors say randomized trials are needed before PRP becomes routine care. The findings support larger studies of this approach.

RRM Context

Restorative reproductive medicine asks why ovarian function declined. The approach looks for a diagnosable cause before treatment begins. The study measured hormone levels after platelet-rich plasma was given. The authors did not report why each woman's ovarian reserve was low to start. A root-cause evaluation looks for that reason first.

Our editorial summary of this paper, not the article's abstract.

Abstract

Background

Ovarian rejuvenation is an innovative procedure intended to restore ovarian fertility and development during the climacteric and has been used to enhance fertility in women with premature ovarian insufficiency (POI). This retrospective study was conducted to determine the effects of an intraovarian platelet-rich plasma (PRP) injection on ovarian stimulation outcomes in women referred to an in vitro fertilisation centre. Methods-

Population

This was a retrospective observational study, and the inclusion criteria included women of reproductive age with at least one ovary with a history of infertility, hormonal abnormalities, an absence of a menstrual cycle, and premature ovarian failure. During the patient's first consultation, a detailed reproductive history was recorded, a pelvic scan for ovarian size was conducted, and hormonal analysis for follicle-stimulating hormone (FSH), anti-Müllerian hormone (AMH), estradiol (E2), and luteinizing hormone (LH) was conducted.

Results

In the study, 469 women with a history of infertility, hormonal abnormalities, an absence of a menstrual cycle, and premature ovarian failure had hormonal levels recorded up to four months after treatment, and these were included in the study. The volume of peripheral blood required to prepare 6-8 mL of PRP for administration was 40-60 mL. The initial concentration of platelets in the peripheral blood sample was about 25000/µL, whereas the prepared PRP had a concentration of 900.000/µL. A volume of approximately 2-4 mL per ovary, depending on the ovarian volume, was used for the intraovarian injection. PRP intervention had significant effects on FSH concentration at the α = 0.05 level. Statistically significant increases in normal values of FSH and E2were observed for months three and four after the PRP intervention for all age groups.

Conclusions

The results of our observational study revealed that a PRP intraovarian injection is associated with improved ovarian tissue and function. Future randomised clinical trials are needed to shed light on the use of PRP in ovarian rejuvenation before offering it routinely in clinical practice.

Topics

Assisted Reproduction › Add-Ons and Adjuncts › Adjunct Evidence Base · Reproductive Endocrinology › Ovarian Hormones › Estrogen · Longevity and Reproductive Aging › Reproductive Aging › Ovarian Aging

Mattheos Fraidakis, Giorgios Giannakakis, Aliki Anifantaki, Meltini Skouradaki, Paraskevi Tsakoumi, Popi Bitzopoulou, Sofia Kourpa, Alexandros Zervakis, Persefoni Kakouri

M Fraidakis, G Giannakakis, A Anifantaki, M Skouradaki, P Tsakoumi, P Bitzopoulou, S Kourpa, A Zervakis, P Kakouri

PMID 37288228 37288228 DOI 10.7759/cureus.38674 10.7759/cureus.38674 Fraidakis et al. 2023, Fraidakis 2023

Intraovarian Platelet-Rich Plasma Injections: Safety and Thoughts on Efficacy Based on a Single Centre Experience With 469 Women

FSH levels fell after ovarian PRP injections in 469 women

Key Findings

Interpretation

RRM Context

Abstract

Topics

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