Ovarian reserve parameters and IVF outcomes in 510 women with poor ovarian  response (POR) treated with intraovarian injection of autologous platelet rich  plasma (PRP)

Yigit Cakiroglu; Aysen Yuceturk; Ozge Karaosmanoglu; Sule Yildirim Kopuk; Zeynep Ece Utkan Korun; Nola Herlihy; Richard T Scott; Bulent Tiras; Emre Seli

doi:10.18632/aging.203972

Assisted Reproduction Add-Ons and Adjuncts

Ovarian reserve parameters and IVF outcomes in 510 women with poor ovarian response (POR) treated with intraovarian injection of autologous platelet rich plasma (PRP)

Cakiroglu Y, Yuceturk A, Karaosmanoglu O, Kopuk SY, Korun ZEU, Herlihy N, Scott RT, Tiras B, Seli E

Published March 22, 2022 Aging, 14(6), 2513-2523

DOI 10.18632/aging.203972 PMID 35320118 PMC PMC9004561

RRM Academy Synopsis

About 1 in 5 women given PRP for poor ovarian response got pregnant

About 20 out of 100 women in this study became pregnant after PRP. About 13 out of 100 had sustained implantation or live birth. The prospective observational study injected platelet rich plasma (PRP) into the ovaries of 510 women with poor ovarian response. Their mean age was 40.3.

Key Findings

The study enrolled 510 women aged 30 to 45 with poor ovarian response by POSEIDON criteria. Each received an ovarian injection of platelet rich plasma (PRP) made from her own blood.
Across all 510 women, the pregnancy rate was 20.5% and the sustained implantation or live birth rate was 12.9%. Sustained implantation meant a heartbeat at about 12 weeks.
Spontaneous pregnancy occurred in 22 women (4.3%) after PRP. Ten of those pregnancies ended in miscarriage, and 12 of 22 (54.5%) reached sustained implantation or live birth.
Of 474 women who attempted IVF, 312 (65.8%) generated embryos, 83 (17.5%) became pregnant and 54 (11.4%) reached sustained implantation or live birth.
On average, antral follicle count and AMH were higher after PRP than before it, and FSH was lower, each at p<0.001, in the same women.

Interpretation

The authors ran a prospective observational study of one group of women at one hospital in Istanbul. They compared measurements and IVF cycles after PRP with those before it. The group had no control arm. Women aged 38 or older made up 378 of the 510 (74.1%), and the oldest group had the lowest pregnancy and live birth percentages. The authors state that their findings do not suggest PRP prevents the age-related rise in aneuploidy. They advise against routine PRP treatment for poor ovarian response until randomized trials show efficacy.

RRM Context

Poor ovarian response is a label based on age or other risk factors, a low egg yield in an earlier cycle and an abnormal ovarian reserve test. The label does not say why reserve is low. Restorative reproductive medicine approaches low reserve as a question of cause, and evaluation of both partners comes first. IVF with an add-on such as PRP proceeds without establishing why conception has not occurred.

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

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.

Topics

Assisted Reproduction › Add-Ons and Adjuncts › Adjunct Evidence Base · Therapeutics › Emerging Therapies › Platelet-Rich Plasma · Reproductive Endocrinology › Ovarian Hormones › Estrogen

Yigit Cakiroglu, Aysen Yuceturk, Ozge Karaosmanoglu, Sule Yildirim Kopuk, Zeynep Ece Utkan Korun, Nola Herlihy, Richard T Scott, Bulent Tiras, Emre Seli

Y Cakiroglu, A Yuceturk, O Karaosmanoglu, S Kopuk, Z Korun, N Herlihy, Rick Scott, Dick Scott, Rich Scott, R Scott, B Tiras, E Seli

PMID 35320118 35320118 DOI 10.18632/aging.203972 10.18632/aging.203972 Cakiroglu et al. 2022, Cakiroglu 2022