Abstract
The first published description of intraovarian platelet-rich plasma (PRP) appeared in mid-2016, when a new experimental technique was successfully used in adult human ovaries to correct the reduced fertility potential accompanying advanced maternal age. Considering the potential therapeutic scope of intraovarian PRP would likely cover both menopause and infertility, the mainstream response has ranged from skeptical disbelief to welcome astonishment. Indeed, reports of intraovarian PRP leading to restored menses in menopause (as an alternative to conventional hormone replacement therapy) and healthy term livebirths for infertility patients (from IVF or as unassisted conceptions) continue to draw notice. Yet, any proper criticism of ovarian PRP applications will be difficult to rebut given the heterogenous patient screening, varied sample preparations, wide differences in platelet incubation and activation protocols, surgical/anesthesia techniques, and delivery methods. Notwithstanding these aspects, no adverse events have thus far been reported and ovarian PRP appears well tolerated by patients. Here, early studies guiding the transition of ‘ovarian rejuvenation’ from experimental to clinical are outlined, with mechanisms to explain results observed in both veterinary and human ovarian PRP research. Current and future challenges for intraovarian cytokine treatment are also discussed.
Highlights
Platelet-rich plasma (PRP) represents a physiologic signaling aggregate comprising hundreds of platelet derived cytokines obtained from blood samples, collected by standard venipuncture [1]
While intraovarian PRP is usually regarded as a precursor to IVF, the ‘reset’ established after platelet cytokine treatment can confer benefits even if not followed by such complex treatments [15,16,17]
What might PRP accomplish in the setting of impaired or even obliterated reserve as with menopause? This question was explored in an animal model where intraperitoneal 4-vinylcyclohexene dioxide administration was used as a gonadotoxin for total ovarian collapse
Summary
Platelet-rich plasma (PRP) represents a physiologic signaling aggregate comprising hundreds of platelet derived cytokines obtained from blood samples, collected by standard venipuncture [1]. The claim to ‘rewind the biological clock’ [3] has been cautiously received It is not known how many IVF clinics offer ‘ovarian rejuvenation’ it is a safe assumption the number was zero prior to 2016. It is known that ovarian perfusion corresponds closely with intrafollicular oxygenation, and those follicles with the lowest dissolved oxygen levels most often provide oocytes with cytoplasmic and chromosomal error [11]. When this imbalance remains uncorrected, embryos least likely to implant originate from follicles which showed impaired vascularity [11]. What research exists to support proposed PRP pathways leading to ovarian rejuvenation?
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