OVARIAN AUTOLOGOUS PLATELET-RICH PLASMA (PRP) TREATMENT IMPROVES OOCYTE AND EMBRYO QUALITY IN WOMEN WITH POOR OVARIAN RESPONSE

Abstract

The application of platelet rich plasma (PRP) as a non-operative treatment is an innovative approach, introduced only recently in reproductive medicine. A few case studies have shown that intraovarian injection of PRP in women with poor ovarian reserve resulted in an increased number of MII oocytes and cleavage-stage embryos. However, little is known about the effect of autologous ovarian PRP treatment on oocyte and embryo quality. The objective of the present study was to evaluate the role of ovarian PRP treatment on the number and quality of oocytes and embryos in women with poor ovarian response undergoing IVF cycles. Prospective cohort study A total of 132 women with a history of poor ovarian response (according to the Bologna criteria) in the previous cycle(s) were included in this prospective study between June 2019 and February 2020. They were treated with ovarian autologous PRP injection in two subsequent menstrual cycles. Approximately 21 ml autologous blood obtained from peripheral vein was obtained and used to prepare PRP following standard protocols. PRP injection was performed using a 21Gx11.8 inch needle under transvaginal ultrasound guidance. Antral follicle counts (AFC) and FSH levels were determined at baseline. Biomarkers of ovarian reserve (AFC and FSH) and IVF outcome variables (fertilization rate, number and quality of MII oocytes, and the number and quality of blastocysts) were recorded and compared between the cycle before and after PRP treatment. All collected oocytes and obtained Day 5 embryos were graded morphologically (Grades 1–3; Grade 1 being highest relative quality and Grade 3 being the lowest quality of the three grades) based on the standard methods. The results were analysed using Student’s paired t-test. P<0.05 was considered statistically significant. Ovarian PRP treatment resulted in insignificantly lower FSH (12.6±1.46 vs. 13.8±1.55, P=0.37) and slightly higher number of mature follicles (3.4±1.8 vs. 2.8±1.5, P=0.56). There were also insignificant increases in the number of retrieved oocytes (4.71±2.6 vs. 4.63±2.8, P=0.34, respectively), fertilization rate (81 vs. 79, P = 0.81) and, consequently the total number of Day 5 embryos (3.93±0.43 vs. 3.29±0.39, P=0.23). However, the percentage of high-quality MII oocytes (67.2% vs. 40.7%, P=0.03) and the percentage of grade-I blastocysts (65.56% vs. 45.89%, P=0.05) were significantly higher after PRP treatment in comparison to the pretreatment period. In addition, the mean MII oocyte quality (1.76±0.61 vs. 2.03±0.73, P=0.05) and blastocyst quality (1.49±0.57 vs. 2.11±0.92, P=0.03) were significantly improved in the post-treatment period. The applied autologous ovarian PRP treatment is an effective approach in improving oocyte and embryo quality in poor responders. This approach may contribute to increased pregnancy rates.