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

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

doi:10.3390/jcm9061809

Konstantinos Sfakianoudis, Konstantinos Pantos + Show 10 more

Open Access

https://doi.org/10.3390/jcm9061809

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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.

Highlights

Clinicians are often called to address the challenging issue of ovarian insufficiency in the context of fertility treatment [1]
Thirteen women (43.3%) positively responded to platelet-rich plasma (PRP) treatment, constituting what is described as the PRP success subgroup for this pilot study
Regarding the PRP success subgroup, antral follicle count (AFC) along with anti-müllerian hormone (AMH), Follicle Stimulating Hormone (FSH), luteinizing hormone (LH) and E2 presented statistically significantly improved from the first month of the follow-up post PRP treatment

Summary

Introduction

The POSEIDON (Patient-Oriented Strategies Encompassing Individualized Oocyte Number) group proposed a new stratification employing a respective developed algorithm to categorize patients based on qualitative and quantitative parameters: (a) maternal age and the expected aneuploidy rate, (b) ovarian reserve biomarker levels such as antral follicle count (AFC) and anti-müllerian hormone (AMH), and c) ovarian response data in previous cycles following ovarian stimulation protocols. This approach offers a practical endpoint to clinicians by assisting in setting a clear goal for management of the group of “low prognosis patients” in assisted reproduction treatment (ART) [8,9]. Of the definition, POR women commonly present with scarcity of stimulable follicles resulting in low oocyte yield, and high cancellation rates following ART [8]

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