Efficacy of intraovarian autologous platelet-rich plasma administration in women with low ovarian reserve: A systematic review and meta-analysis

Abstract

Objective: To conduct a systematic examination and meta-analysis of the most reliable data from experimental studies evaluating the efficacy of autologous platelet-rich plasma (PRP) on low ovarian reserve.

Methods: A comprehensive search was performed utilizing pertinent search terms across electronic databases, including PubMed, Cochrane, and Google Scholar. We included studies that assigned infertile women with low ovarian reserve in experimental studies. Ovarian reserve parameters were measured before and after PRP injection into ovaries. The data of each study was retrieved and subsequently compiled.

Results: Of 301 articles collected and reviewed, six studies were finally included in the meta-analysis. Following PRP injection, infertile women showed a non-significant increase in anti-Mullerian hormone (AMH) level (MD=0.10; 95% CI -0.04, 0.23), a significant increase in antral follicular count (AFC) (MD=1.88; 95% CI 0.47, 3.29), and a non-significant reduction in follicle-stimulating hormone (FSH) level (MD=-0.22; 95% CI -8.32, 7.87).

Conclusions: Autologous PRP may increase AFC, but not AMH. Although it is found beneficial in enhancing ovarian reserve (AFC), further research with strong evidence is still required.

Keywords

Platelet-rich plasma / Low ovarian reserve / Ovarian rejuvenation

Conflict of interest statement

The authors declare that they have no conflict of interest.

Funding

No external funding was either sought or obtained for this study.

Authors’ contributions

Yasmin Sabina Sa'diah and Agung Dewanto designed the study and guided the methodology. Yasmin Sabina Sa'diah and Lukman A Chandra were responsible for searching, selecting, and extracting data and wrote the first draft. Yasmin Sabina Sa'diah, Agung Dewanto and Lukman A Chandra reviewed and discussed the manuscript. All authors approve and are responsible for publication.

Publisher’s Note

The Publisher of the Journal remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

References

[1] Eniola W, Adetola A, Abayomi T. A review of female infertility; important etiological factors and management. J Microbiol Biotech Res 2012; 2(3): 379-385.

[2] Gürkan N, Dokuzeylül Güngör N, Ayar Madenli A, Alanya Tosun S. Evaluation of the impact of platelet-rich plasma in women with reduced ovarian reserve. J Heal Sci Med 2022; 5(5): 1334-1338.

[3] Scott Sills E, Wood SH. Autologous activated platelet-rich plasma injection into adult human ovary tissue: Molecular mechanism, analysis, and discussion of reproductive response. Biosci Rep 2019; 39(6): 1-15.

[4] Vo TKC, Tanaka Y, Kawamura K. Ovarian rejuvenation using autologous platelet-rich plasma. Endocrines 2021; 2(1): 15-27.

[5] Na JI, Choi JW, Choi HR, Jeong JB, Park KC, Youn SW, et al. Rapid healing and reduced erythema after ablative fractional carbon dioxide laser resurfacing combined with the application of autologous platelet- rich plasma. Dermatologie Surg 2011; 37(4): 463-468.

[6] Foster TE, Puskas BL, Mandelbaum BR, Gerhardt MB, Rodeo SA. Platelet-rich plasma: From basic science to clinical applications. Am J Sports Med 2009; 37(11): 2259-2272.

[7] Fabi S, Sundaram H. The potential of topical and injectable growth factors and cytokines for skin rejuvenation. Facial Plast Surg 2014; 30(2): 157-171.

[8] Tufanaru C, Munn Z, Stephenson M, Aromataris E. Fixed or random effects meta-analysis? Common methodological issues in systematic reviews of effectiveness. Int J Evid Based Healthc 2015; 13(3): 196-207.

[9] Abdullah TH, Abbas SH, Al-Obaidi MT, Abdulraheem Y. The efficacy of platelets rich plasma (PRP) for ovarian rejuvenation. Indian J Public Heal Res Dev 2019; 10(8): 1211-1217.

[10] Uddin MJ, Banu J, Ishrat S, Sultana S, Munira S, Shume MM, et al. Effect of autologous platelet rich plasma on anti-Mullerian hormone and antral follicle count in sub fertile women with poor ovarian reserve. Int J Reprod Contracept Obstet Gynecol 2022; 11(2): 292.

[11] Aflatoonian A, Lotfi M, Saeed L, Tabibnejad N. Effects of intraovarian injection of autologous platelet-rich plasma on ovarian rejuvenation in poor responders and women with primary ovarian insufficiency. Reprod Sci 2021; 28(7): 2050-2059.

[12] Navali N, Sadeghi L, Farzadi L, Ghasemzadeh A, Hamdi K, Hakimi P, et al. Intraovarian injection of autologous platelet-rich plasma improves therapeutic approaches in the patients with poor ovarian response: A before-after study. Int J Fertil Steril 2022; 16(2): 90-94.

[13] Sills ES, Petersen JL, Rickers NS, Wood SH, Li X. Regenerative effect of intraovarian injection of activated autologous platelet-rich plasma: Serum anti-Mullerian hormone levels measured among poor-prognosis in vitro fertilization patients. Int J Regen Med 2020; 1-5. doi: 10.31487/j.rgm.2020.01.02.

[14] Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. PLoS Med 2021; 18(3): 1-15.

[15] Higgins JPT, Savović J, Page MJ, Sterne JAC. A revised tool to assess risk of bias in randomized trials (RoB 2.0). J Cochrane Database System Rev 2016; 10(Suppl 1): 29-31.

[16] Park H, Yang J, Chung K. Characterization of the cytokine profile of platelet rich plasma (PRP) and PRP-induced cell proliferation and migration: Upregulation of matrix metalloproteinase-1 and -9 in HaCaT cells. Korean J Hematol 2011; 46(4): 265-273. doi: 10.5045/kjh.2011.46.4.265.

[17] Sánchez-González DJ, Méndez-Bolaina E, Trejo-Bahena NI. Platelet-rich plasma peptides: Key for regeneration. Int J Pept 2012; 2012: 532519. doi: 10.1155/2012/532519.

[18] Krüger JP, Freymann U, Vetterlein S, Neumann K, Endres M, Kaps C. Bioactive factors in platelet-rich plasma obtained by apheresis. Transfus Med Hemotherapy 2013; 40(6): 432-440.

[19] Melo P, Navarro C, Jones C, Coward K, Coleman L. The use of autologous platelet-rich plasma (PRP) versus no intervention in women with low ovarian reserve undergoing fertility treatment: A non- randomized interventional study. J Assist Reprod Genet 2020; 37(4): 855-863.

[20] Sills ES, Rickers NS, Li X, Palermo GD. First data on in vitro fertilization and blastocyst formation after intraovarian injection of calcium gluconate-activated autologous platelet rich plasma. Gynecol Endocrinol 2018; 34(9): 756-760.

[21] Gaytán F, Morales C, García-Pardo L, Reymundo C, Bellido C, Sánchez- Criado JE. A quantitative study of changes in the human corpus luteum microvasculature during the menstrual cycle. Biol Reprod 1999; 60(4): 914-919.

[22] Yu EJ, Ahn H, Lee JM, Jee BC, Kim SH. Fertilization and embryo quality of mature oocytes with specific morphological abnormalities. Clin Exp Reprod Med 2015; 42(4): 156-162.