How Does Platelet-Rich Plasma Injection in Ovaries of Poor Responders Affect the Retrieved Oocytes, and Anti Mullerian Hormone: A Clinical Trial
Abstract
Objective: Platelet Rich Plasma (PRP) is proposed to have important role in cell division and proliferation, angiogenesis and health. This study evaluates the effect of a single injection of autologous PRP on ovarian response markers in women with poor ovarian response (POR).
Materials and methods: This non-randomized clinical trial was conducted between August 2020 and September 2021. Fifty six women with Bologna criteria for POR willingly chose to participate in one of the following groups: PRP for one cycle in the time of oocyte pickup (OPU) (intervention group, n= 34) or control group (n=22).The primary outcomes were: number and quality of oocytes in coming 2 cycles of ICSI, and Anti Mullerian Hormone (AMH) level two months after PRP injection. The secondary outcomes were the number and quality of embryos and chemical pregnancy rate after embryo transfer.
Results: A total of 45 participants continued the study, of which 23 were in the intervention group and 22 in control group. There were no demographic differences between two groups. At a two cycle follow up, PRP group experienced a significant improvement in AMH level and there was no respective change in control group. In one year follow up the overall pregnancy rates were same in both groups (3% Vs. 0, p=.60), while there was no difference in cumulative number and quality of embryos.
Conclusion: PRP injection can improve ovarian reserve marker without adverse effects. Further evidence is required to evaluate the impact of PRP on assisted reproduction outcomes.
1. Wang RR, Su MH, Liu LY, Lai YY, Guo XL, Gan D, et al. Systematic review of acupuncture to improve ovarian function in women with poor ovarian response. Front Endocrinol (Lausanne) 2023; 14: 1028853.
2. Ferraretti AP, La Marca A, Fauser BC, Tarlatzis B, Nargund G, Gianaroli L; et al. ESHRE consensus on the definition of 'poor response' to ovarian stimulation for in vitro fertilization: the Bologna criteria. Hum Reprod 2011; 26: 1616-24.
3. Bendikson K, Milki AA, Speck-Zulak A, Westphal LM. Comparison of GnRH antagonist cycles with and without oral contraceptive pill pretreatment in poor responders. Clin Exp Obstet Gynecol 2006; 33: 145-7.
4. Jayaprakasan K, Campbell B, Hopkisson J, Johnson I, Raine-Fenning N. A prospective, comparative analysis of anti-Müllerian hormone, inhibin-B, and three-dimensional ultrasound determinants of ovarian reserve in the prediction of poor response to controlled ovarian stimulation. Fertil Steril 2010; 93: 855-64.
5. Patrelli TS, Gizzo S, Sianesi N, Levati L, Pezzuto A, Ferrari B, et al. Anti-Müllerian hormone serum values and ovarian reserve: can it predict a decrease in fertility after ovarian stimulation by ART cycles? PLoS One 2012; 7: e44571.
6. La Marca A, Sighinolfi G, Radi D, Argento C, Baraldi E, Artenisio AC,et al.Anti-Müllerian hormone (AMH) as a predictive marker in assisted reproductive technology (ART). Hum Reprod Update 2010; 16: 113-30.
7. Mohammed Yassin M, Akram Sharif F, Marwan Laqqan M. Anti-mullerian hormone as a predictor of ovarian reserve and ovarian response in IVF women from Gaza strip. Iran J Reprod Med 2013; 11: 261-6.
8. Jirge PR, Patil MM, Gutgutia R, Shah J, Govindarajan M, Roy VS, et al. Ovarian Stimulation in Assisted Reproductive Technology Cycles for Varied Patient Profiles: An Indian Perspective. J Hum Reprod Sci 2022; 15: 112-25.
9. Jang HY, Myoung SM, Choe JM, Kim T, Cheon YP, Kim YM, et al .Effects of autologous platelet-rich plasma onregeneration of damaged endometrium in female rats. Yonsei Med J 2017; 58: 1195–203.
10. Molina A, Sánchez J, Sánchez W, Vielma V. Platelet-rich plasma as an adjuvant in the endometrial preparation of patients with refractory endometrium. JBRA Assist Reprod 2018; 22: 42-8.
11. Farimani M, Bahmanzadeh M, Poorolajal J. A New Approach Using Autologous Platelet-Rich Plasma (PRP) to Treat Infertility and To Improve Population Replacement Rate. J Res Health Sci 2016; 16: 172-3.
12. Farimani M, Poorolajal J, Rabiee S, Bahmanzadeh M. Successful pregnancy and live birth after intrauterine administration of autologous platelet-rich plasma in a woman with recurrent implantation failure: A case report. Int J Reprod Biomed 2017; 15: 803-6.
13. Sighinolfi G, Sunkara SK, La Marca A. New strategies of ovarian stimulation based on the concept of ovarian follicularwaves: from conventional to random and double stimulation. Reprod Biomed Online 2018; 37:489-97.
14. Das D, Arur S. Conserved insulin signaling in the regulation of oocyte growth, development, and maturation. Mol Reprod Dev 2017; 84: 444–59.
15. Emori C, Sugiura K . Role of oocyte-derived paracrinefactors in follicular development. Anim Sci
J 2014; 85: 627-33.
16. Marini MG, Perrini C, Esposti P, Corradetti B, Bizzaro D, Riccaboni P, et al. Effects of platelet-rich plasma in a model of bovine endometrial inflammation in vitro. Reprod Biol Endocrinol 2016; 14: 58.
17. Xie X, Zhang C, Tuan RS. Biology of platelet-rich plasma and its clinical application in cartilage repair. Arthritis Res Ther 2014; 16: 204.
18. Sekerci CA, Tanidir Y, Sener TE, Sener G, Cevik O, Yarat A, e al. Effects of platelet-rich plasma against experimental ischemia/reperfusion injury in rat testis.
J Pediatr Urol 2017; 13: 317.e1-317.e9.
19. Farimani M, Heshmati S, Poorolajal J, Bahmanzadeh M. A report on three live births in women with poor ovarian response following intra-ovarian injection of platelet-rich plasma (PRP). Mol Biol Rep 2019; 46: 1611-6.
20. La Marca A, Grisendi V, Giulini S, Sighinolfi G, Tirelli A, Argento C, Re C, Tagliasacchi D, Marsella T, Sunkara SK. Live birth rates in the different combinations of the Bologna criteria poor ovarian responders: a validation study. J Assist Reprod Genet 2015; 32: 931-7.
21. Keikha F, Shahsavari S, Salari Y, Roozbeh N, Haghollahi F, Tarazjani MD, et al. One Side Ovarian Rejuvenation: A Quasi-Experimental Study of the Effect of the Autologous Platelet Rich Plasma in Poor Ovarian Responders in IVF. Ethiop J Health Sci 2022; 32: 1133-40.
22. Aziminekoo E, Mohseni Salehi MS, Kalantari V, Shahrokh Tehraninejad E, Haghollahi F, Hossein Rashidi B, et al. Pregnancy outcome after blastocyst stage transfer comparing to early cleavage stage embryo transfer. Gynecol Endocrinol 2015; 31: 880-4.
23. Hosseinisadat R, Farsi Nejad A, Mohammadi F. Intra-ovarian infusion of autologous platelet-rich plasma in women with poor ovarian reserve: A before and after study. Eur J Obstet Gynecol Reprod Biol 2023; 280: 60-3.
24. 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: 855-63.
25. Cakiroglu Y, Saltik A, Yuceturk A, Karaosmanoglu O, Kopuk SY, Scott RT, et al. Effects of intraovarian injection of autologous platelet rich plasma on ovarian reserve and IVF outcome parameters in women with primary ovarian insufficiency. Aging (Albany NY) 2020; 12: 10211-22.
26. Pantos K, Simopoulou M, Pantou A, Rapani A, Tsioulou P, Nitsos N, et al. A Case Series on Natural Conceptions Resulting in Ongoing Pregnancies in Menopausal and Prematurely Menopausal Women Following Platelet-Rich Plasma Treatment. Cell Transplant 2019; 28: 1333-40.
27. 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: 756-60.
28. Sfakianoudis K, Simopoulou M, Nitsos N, Rapani A, Pantou A, Vaxevanoglou T, et al. A Case Series on Platelet-Rich Plasma Revolutionary Management of Poor Responder Patients. Gynecol Obstet Invest 2019; 84: 99-106.
29. Panda SR, Sachan S, Hota S. A Systematic Review Evaluating the Efficacy of Intra-Ovarian Infusion of Autologous Platelet-Rich Plasma in Patients With Poor Ovarian Reserve or Ovarian Insufficiency. Cureus 2020; 12: e12037.
30. Sharara FI, Lelea LL, Rahman S, Klebanoff JS, Moawad GN. A narrative review of platelet-rich plasma (PRP) in reproductive medicine. J Assist Reprod Genet 2021; 38: 1003-12.
31. 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: 2050-9.
32. Borrione P, Gianfrancesco AD, Pereira MT, Pigozzi F. Platelet-rich plasma in muscle healing. Am J Phys Med Rehabil 2010; 89: 854-61.
33. KINGSLEY CS. Blood coagulation; evidence of an antagonist to factor VI in platelet-rich human plasma. Nature 1954; 173: 723-4.
34. Fanciulli G, Delitala A, Delitala G. Growth hormone, menopause and ageing: no definite evidence for 'rejuvenation' with growth hormone. Hum Reprod Update 2009; 15: 341-58.
35. Atkinson L, Martin F, Sturmey RG. Intraovarian injection of platelet-rich plasma in assisted reproduction: too much too soon? Hum Reprod 2021; 36: 1737-50.
36. Farimani M, Nazari A, Mohammadi S, Anvari Aliabad R. Evaluation of intra-ovarian platelet-rich plasma administration on oocytes-dependent variables in patients with poor ovarian response: A retrospective study according to the POSEIDON criteria. Reprod Biol Endocrinol 2021; 19: 137.
37. Cremonesi F, Bonfanti S, Idda A, Anna LC. Improvement of Embryo Recovery in Holstein Cows Treated by Intra-Ovarian Platelet Rich Plasma before Superovulation. Vet Sci 2020; 7: 16.
38. Elnashar AM. Intraovarian platelet-rich plasma: current status. Middle East Fertil Soc J 2021; 26: 30.
39. Farimani M, Nazari A, Mohammadi S, Anvari Aliabad R. Evaluation of intra-ovarian platelet-rich plasma administration on oocytes-dependent variables in patients with poor ovarian response: A retrospective study according to the POSEIDON criteria. Reprod Biol Endocrinol 2021; 19: 137.
40. 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: 90-4.
41. Parvanov D, Ganeva R, Vidolova N, Nikolova K, Vasileva M, Totev T, et al. Autologous ovarian platelet rich plasma treatment improves oocyte and embryo quality: a before-after prospective study. Biotechnol Biotechnol Equip 2022; 36: 425-32.
42. Tülek F, Kahraman A. The effects of intra-ovarian autologous platelet rich plasma injection on IVF outcomes of poor responder women and women with premature ovarian insufficiency. J Turk Ger Gynecol Assoc 2022; 23: 14–21.
43. Davari Tanha F, Salimi Setudeh S, Ebrahimi M, Feizabad E, Khalaj Sereshki Z, Akbari Asbagh F, et al. Effect of intra-ovarian platelet rich plasma in women with poor ovarian response. Caspian J Intern Med 2023; 14: 485-9.
2. Ferraretti AP, La Marca A, Fauser BC, Tarlatzis B, Nargund G, Gianaroli L; et al. ESHRE consensus on the definition of 'poor response' to ovarian stimulation for in vitro fertilization: the Bologna criteria. Hum Reprod 2011; 26: 1616-24.
3. Bendikson K, Milki AA, Speck-Zulak A, Westphal LM. Comparison of GnRH antagonist cycles with and without oral contraceptive pill pretreatment in poor responders. Clin Exp Obstet Gynecol 2006; 33: 145-7.
4. Jayaprakasan K, Campbell B, Hopkisson J, Johnson I, Raine-Fenning N. A prospective, comparative analysis of anti-Müllerian hormone, inhibin-B, and three-dimensional ultrasound determinants of ovarian reserve in the prediction of poor response to controlled ovarian stimulation. Fertil Steril 2010; 93: 855-64.
5. Patrelli TS, Gizzo S, Sianesi N, Levati L, Pezzuto A, Ferrari B, et al. Anti-Müllerian hormone serum values and ovarian reserve: can it predict a decrease in fertility after ovarian stimulation by ART cycles? PLoS One 2012; 7: e44571.
6. La Marca A, Sighinolfi G, Radi D, Argento C, Baraldi E, Artenisio AC,et al.Anti-Müllerian hormone (AMH) as a predictive marker in assisted reproductive technology (ART). Hum Reprod Update 2010; 16: 113-30.
7. Mohammed Yassin M, Akram Sharif F, Marwan Laqqan M. Anti-mullerian hormone as a predictor of ovarian reserve and ovarian response in IVF women from Gaza strip. Iran J Reprod Med 2013; 11: 261-6.
8. Jirge PR, Patil MM, Gutgutia R, Shah J, Govindarajan M, Roy VS, et al. Ovarian Stimulation in Assisted Reproductive Technology Cycles for Varied Patient Profiles: An Indian Perspective. J Hum Reprod Sci 2022; 15: 112-25.
9. Jang HY, Myoung SM, Choe JM, Kim T, Cheon YP, Kim YM, et al .Effects of autologous platelet-rich plasma onregeneration of damaged endometrium in female rats. Yonsei Med J 2017; 58: 1195–203.
10. Molina A, Sánchez J, Sánchez W, Vielma V. Platelet-rich plasma as an adjuvant in the endometrial preparation of patients with refractory endometrium. JBRA Assist Reprod 2018; 22: 42-8.
11. Farimani M, Bahmanzadeh M, Poorolajal J. A New Approach Using Autologous Platelet-Rich Plasma (PRP) to Treat Infertility and To Improve Population Replacement Rate. J Res Health Sci 2016; 16: 172-3.
12. Farimani M, Poorolajal J, Rabiee S, Bahmanzadeh M. Successful pregnancy and live birth after intrauterine administration of autologous platelet-rich plasma in a woman with recurrent implantation failure: A case report. Int J Reprod Biomed 2017; 15: 803-6.
13. Sighinolfi G, Sunkara SK, La Marca A. New strategies of ovarian stimulation based on the concept of ovarian follicularwaves: from conventional to random and double stimulation. Reprod Biomed Online 2018; 37:489-97.
14. Das D, Arur S. Conserved insulin signaling in the regulation of oocyte growth, development, and maturation. Mol Reprod Dev 2017; 84: 444–59.
15. Emori C, Sugiura K . Role of oocyte-derived paracrinefactors in follicular development. Anim Sci
J 2014; 85: 627-33.
16. Marini MG, Perrini C, Esposti P, Corradetti B, Bizzaro D, Riccaboni P, et al. Effects of platelet-rich plasma in a model of bovine endometrial inflammation in vitro. Reprod Biol Endocrinol 2016; 14: 58.
17. Xie X, Zhang C, Tuan RS. Biology of platelet-rich plasma and its clinical application in cartilage repair. Arthritis Res Ther 2014; 16: 204.
18. Sekerci CA, Tanidir Y, Sener TE, Sener G, Cevik O, Yarat A, e al. Effects of platelet-rich plasma against experimental ischemia/reperfusion injury in rat testis.
J Pediatr Urol 2017; 13: 317.e1-317.e9.
19. Farimani M, Heshmati S, Poorolajal J, Bahmanzadeh M. A report on three live births in women with poor ovarian response following intra-ovarian injection of platelet-rich plasma (PRP). Mol Biol Rep 2019; 46: 1611-6.
20. La Marca A, Grisendi V, Giulini S, Sighinolfi G, Tirelli A, Argento C, Re C, Tagliasacchi D, Marsella T, Sunkara SK. Live birth rates in the different combinations of the Bologna criteria poor ovarian responders: a validation study. J Assist Reprod Genet 2015; 32: 931-7.
21. Keikha F, Shahsavari S, Salari Y, Roozbeh N, Haghollahi F, Tarazjani MD, et al. One Side Ovarian Rejuvenation: A Quasi-Experimental Study of the Effect of the Autologous Platelet Rich Plasma in Poor Ovarian Responders in IVF. Ethiop J Health Sci 2022; 32: 1133-40.
22. Aziminekoo E, Mohseni Salehi MS, Kalantari V, Shahrokh Tehraninejad E, Haghollahi F, Hossein Rashidi B, et al. Pregnancy outcome after blastocyst stage transfer comparing to early cleavage stage embryo transfer. Gynecol Endocrinol 2015; 31: 880-4.
23. Hosseinisadat R, Farsi Nejad A, Mohammadi F. Intra-ovarian infusion of autologous platelet-rich plasma in women with poor ovarian reserve: A before and after study. Eur J Obstet Gynecol Reprod Biol 2023; 280: 60-3.
24. 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: 855-63.
25. Cakiroglu Y, Saltik A, Yuceturk A, Karaosmanoglu O, Kopuk SY, Scott RT, et al. Effects of intraovarian injection of autologous platelet rich plasma on ovarian reserve and IVF outcome parameters in women with primary ovarian insufficiency. Aging (Albany NY) 2020; 12: 10211-22.
26. Pantos K, Simopoulou M, Pantou A, Rapani A, Tsioulou P, Nitsos N, et al. A Case Series on Natural Conceptions Resulting in Ongoing Pregnancies in Menopausal and Prematurely Menopausal Women Following Platelet-Rich Plasma Treatment. Cell Transplant 2019; 28: 1333-40.
27. 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: 756-60.
28. Sfakianoudis K, Simopoulou M, Nitsos N, Rapani A, Pantou A, Vaxevanoglou T, et al. A Case Series on Platelet-Rich Plasma Revolutionary Management of Poor Responder Patients. Gynecol Obstet Invest 2019; 84: 99-106.
29. Panda SR, Sachan S, Hota S. A Systematic Review Evaluating the Efficacy of Intra-Ovarian Infusion of Autologous Platelet-Rich Plasma in Patients With Poor Ovarian Reserve or Ovarian Insufficiency. Cureus 2020; 12: e12037.
30. Sharara FI, Lelea LL, Rahman S, Klebanoff JS, Moawad GN. A narrative review of platelet-rich plasma (PRP) in reproductive medicine. J Assist Reprod Genet 2021; 38: 1003-12.
31. 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: 2050-9.
32. Borrione P, Gianfrancesco AD, Pereira MT, Pigozzi F. Platelet-rich plasma in muscle healing. Am J Phys Med Rehabil 2010; 89: 854-61.
33. KINGSLEY CS. Blood coagulation; evidence of an antagonist to factor VI in platelet-rich human plasma. Nature 1954; 173: 723-4.
34. Fanciulli G, Delitala A, Delitala G. Growth hormone, menopause and ageing: no definite evidence for 'rejuvenation' with growth hormone. Hum Reprod Update 2009; 15: 341-58.
35. Atkinson L, Martin F, Sturmey RG. Intraovarian injection of platelet-rich plasma in assisted reproduction: too much too soon? Hum Reprod 2021; 36: 1737-50.
36. Farimani M, Nazari A, Mohammadi S, Anvari Aliabad R. Evaluation of intra-ovarian platelet-rich plasma administration on oocytes-dependent variables in patients with poor ovarian response: A retrospective study according to the POSEIDON criteria. Reprod Biol Endocrinol 2021; 19: 137.
37. Cremonesi F, Bonfanti S, Idda A, Anna LC. Improvement of Embryo Recovery in Holstein Cows Treated by Intra-Ovarian Platelet Rich Plasma before Superovulation. Vet Sci 2020; 7: 16.
38. Elnashar AM. Intraovarian platelet-rich plasma: current status. Middle East Fertil Soc J 2021; 26: 30.
39. Farimani M, Nazari A, Mohammadi S, Anvari Aliabad R. Evaluation of intra-ovarian platelet-rich plasma administration on oocytes-dependent variables in patients with poor ovarian response: A retrospective study according to the POSEIDON criteria. Reprod Biol Endocrinol 2021; 19: 137.
40. 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: 90-4.
41. Parvanov D, Ganeva R, Vidolova N, Nikolova K, Vasileva M, Totev T, et al. Autologous ovarian platelet rich plasma treatment improves oocyte and embryo quality: a before-after prospective study. Biotechnol Biotechnol Equip 2022; 36: 425-32.
42. Tülek F, Kahraman A. The effects of intra-ovarian autologous platelet rich plasma injection on IVF outcomes of poor responder women and women with premature ovarian insufficiency. J Turk Ger Gynecol Assoc 2022; 23: 14–21.
43. Davari Tanha F, Salimi Setudeh S, Ebrahimi M, Feizabad E, Khalaj Sereshki Z, Akbari Asbagh F, et al. Effect of intra-ovarian platelet rich plasma in women with poor ovarian response. Caspian J Intern Med 2023; 14: 485-9.
| Files | ||
| Issue | Vol 17, No 3 (September 2023) | |
| Section | Original Articles | |
| DOI | https://doi.org/10.18502/jfrh.v17i3.13539 | |
| Keywords | ||
| Platelet-Rich Plasma Anti-Mullerian Hormone Ovarian Reserve In Vitro Fertilization | ||
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How to Cite
1.
Shahrokh Tehraninejad E, Olsadat Razavi M, Tarafdari Menshadi A, Shariat M, Shahsavari S, Haghollahi F, Azimi Nekoo E. How Does Platelet-Rich Plasma Injection in Ovaries of Poor Responders Affect the Retrieved Oocytes, and Anti Mullerian Hormone: A Clinical Trial. J Family Reprod Health. 2023;17(3):165-173.
