Reactivating Ovarian Function through Autologous Platelet-Rich Plasma Intraovarian Infusion: Pilot Data on Premature Ovarian Insufficiency, Perimenopausal, Menopausal, and Poor Responder Women

Konstantinos Sfakianoudis; Mara Simopoulou; Sokratis Grigoriadis; Agni Pantou; Petroula Tsioulou; Evangelos Maziotis; Anna Rapani; Polina Giannelou; Nikolaos Nitsos; Georgia Kokkali; Michael Koutsilieris; Konstantinos Pantos

doi:10.3390/jcm9061809

Assisted Reproduction · Add-Ons and Adjuncts

Reactivating Ovarian Function through Autologous Platelet-Rich Plasma Intraovarian Infusion: Pilot Data on Premature Ovarian Insufficiency, Perimenopausal, Menopausal, and Poor Responder Women

Sfakianoudis K, Simopoulou M, Grigoriadis S, Pantou A, Tsioulou P, Maziotis E, Rapani A, Giannelou P, Nitsos N, Kokkali G, Koutsilieris M, Pantos K

Published June 10, 2020 Journal of clinical medicine, 9(6)

DOI 10.3390/jcm9061809 PMID 32532000 PMC PMC7355907

RRM Academy Synopsis

Periods returned after ovarian PRP in 6 of 10 women with POI

Periods returned in 6 out of 10 women with premature ovarian insufficiency after platelet-rich plasma (PRP) was injected into their ovaries. This pilot had four groups of 30 women and no comparison group. Regular cycles returned in 8 out of 10 perimenopausal women. Periods returned in about 4 out of 10 menopausal women.

Key Findings

Periods returned in 18 of 30 women with premature ovarian insufficiency (60%). Three of them conceived naturally, and all three had a live birth.
Regular cycles returned in 24 of 30 perimenopausal women (80%). Four conceived naturally, one pregnancy ended in miscarriage, and three ended in a live birth.
Periods returned in 13 of 30 menopausal women (43.3%). One conceived naturally and had a live birth.
Of 30 women with poor ovarian response, 14 (46.6%) had a clinical pregnancy in the ICSI cycle after PRP, and 12 had a live birth. The earlier cycle gave no clinical pregnancy.
The authors report no adverse effects in any of the 120 women during the three-month follow-up.

Interpretation

The report combines four prospective observational cohorts from one Athens clinic. Each had 30 women and no comparison group, so the data cannot show that PRP caused the changes. The poor ovarian response group was compared with its own earlier ICSI cycle. Follow-up lasted three months. The authors describe serious limitations and a high risk of bias, and they say PRP should be considered strictly experimental until randomized trials report. They add that they may be far from able to reassure patients on long-term safety.

RRM Context

Restorative reproductive medicine asks why ovarian function fell before choosing a step. The authors grouped women by label. They left out women with autoimmune disease, endometriosis, thyroid problems and more, so those causes were not studied. For two of the groups, the authors call finding the exact cause an absolute requirement.

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

Abstract

Intraovarian platelet-rich plasma (PRP) infusion was recently introduced in the context of addressing ovarian insufficiency. Reporting on its effectiveness prior to adopting in clinical routine practice is imperative. This study aims to provide pilot data regarding PRP application for ovarian rejuvenation. Four pilot studies were conducted on poor ovarian response (POR), premature ovarian insufficiency (POI), perimenopause, and menopause, respectively. Each pilot study reports on thirty patients, 120 participants were recruited in total. All participants provided written informed consent prior to treatment. Primary outcome measures for the POR pilot study were levels of anti-müllerian hormone (AMH), antral follicle count (AFC) and oocyte yield. For the POI, perimenopausal and menopausal pilot studies primary outcome measures were restoration of menstrual cycle, and Follicle Stimulating Hormone (FSH) levels. A significant improvement on the hormonal profile and the ovarian reserve status was noted, along with improved intracytoplasmic sperm injection (ICSI) cycle performance concerning POR participants. Menstruation recovery was observed in 18 out of 30 POI patients, along with a statistically significant improvement on levels of AMH, FSH, and AFC. Similarly, 13 out of 30 menopausal women positively responded to PRP treatment. Finally, menstruation regularity, improved hormonal levels and AFC were reported for 24 out of 30 perimenopausal women. To conclude, PRP infusion appears to convey promising results in addressing ovarian insufficiency.

Topics

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

Konstantinos Sfakianoudis, Mara Simopoulou, Sokratis Grigoriadis, Agni Pantou, Petroula Tsioulou, Evangelos Maziotis, Anna Rapani, Polina Giannelou, Nikolaos Nitsos, Georgia Kokkali, Michael Koutsilieris, Konstantinos Pantos

K Sfakianoudis, M Simopoulou, S Grigoriadis, A Pantou, P Tsioulou, E Maziotis, A Rapani, P Giannelou, N Nitsos, G Kokkali, Mike Koutsilieris, M Koutsilieris, K Pantos

PMID 32532000 32532000 DOI 10.3390/jcm9061809 10.3390/jcm9061809 Sfakianoudis et al. 2020, Sfakianoudis 2020

Keywords

Platelet-rich plasma, intraovarian infusion, menopause, ovarian rejuvenation, ovarian reserve, perimenopause, poor responders, premature ovarian insufficiency

Reactivating Ovarian Function through Autologous Platelet-Rich Plasma Intraovarian Infusion: Pilot Data on Premature Ovarian Insufficiency, Perimenopausal, Menopausal, and Poor Responder Women

Periods returned after ovarian PRP in 6 of 10 women with POI

Key Findings

Interpretation

RRM Context

Abstract

Topics

By this author

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Keywords