PRP Group & Control Group in Poseidon Poor Responders
Phase: NA
Conditions: Poor Ovarian Reserve, Platelet Derived Growth Factor
Sponsor: Karbala University

The role  of Ovarian PRP Therapy in Poseidon Poor Responders Women 
undergoing ICSI Cycle 
Abstract 
Background: Poor ovarian responders (POR) women represent a challenge issue in assisted 
reproduction techniques (ART). As an effort to optimize conception rates in these patients, 
ovarian platelet-rich-plasma (PRP) injection prior to intracytoplasmic sperm injection (ICSI) 
cycles has been advised to improve both the quantity and quality of oocytes and embryos, owing 
to its regenerative properties for ovarian milieu ultimately improved ART outcomes.  
Objective : This study aims to evaluate the impact of ovarian PRP therapy compared to control 
in Poseidon POR females undergoing ICSI cycles. 
 Material and Methods: A randomized controlled trial was conducted from Jan 2024 to Feb 
2025, involving 102 Poseidon POR women, Participants were divided into a PRP group (n=50), 
who received ovarian PRP injections and a control group (n=52), who received no PRP. All 
participants underwent ICSI cycles, embryological and pregnancy outcomes were compared 
between both groups within each Poseidon group. 
Results: metaphase II (MII) oocytes count showed increment in the PRP group compared to 
controls (p value=0.036). However, the mean number of MII oocytes remained comparable in 
both groups respectively (3.8±2.6 vs 4.2±1.8). Alongside, no significant differences in 
embryological outcomes or pregnancy rates were noticed in PRP and control patients among all 
Poseidon groups (all p value>0.05).  
Conclusion: Although ovarian PRP might increase MII oocytes count in Poseidon POR women 
underwent ICSI cycles. When compared to control, it does not provide significant benefits for 
oocyte and embryo parameters, nor does it improve pregnancy rates in these women.  
Key words: ovarian PRP, IVF cycle, Poseidon poor responders.  
 
The role  of Ovarian PRP Therapy in Poseidon Poor Responders Women undergoing ICSI Cycle. 22/9/2025  

2. 
Materials And Methods  
2.1. Study design This study was conducted at a private fertility center in Karbala, Iraq, from Jan 
2024 to Feb 2025.  All participants provided written informed consent prior to enrollment, and 
ethical approval was obtained from the College of Medicine, Karbala University (reference 
number 25-8). 
2.2. Participants 
 A total of 102 Poseidon POR women were enrolled where Inclusion criteria were infertile 
Poseidon groups 2, 3, 4 women with no history of chronic illness or pelvic pathology. All male 
partners were either normozoospermic or had mild OAT delivered fresh ejaculated samples for 
ICSI.  
Exclusion criteria were ovarian failure due to sex chromosome abnormalities, current use of 
anticoagulants and history of bleeding disorders. Participants were assigned into two groups: 
Study group (n=50), who underwent ovarian PRP injections once or twice times within six 
months prior to ICSI cycle, and control group (n=52), who did not receive PRP therapy. 
2.3. PRP preparation and injection  
Twenty mL of peripheral blood was drawing under sterile conditions using Lora PRP tubes 
(Modern Technology Company). Frist the blood was centrifuged at 1600 rpm for 10 minutes 
(soft spin). Then the plasma and superficial buffy coat were transferred into a sterile tube 
containing no anticoagulant and centrifuged again at 3500 rpm for 5 minutes (hard spin). The 
upper 2/3rd (platelet-poor plasma, PPP) were discarded, and the platelet pellets were 
homogenized in the lower 1/3rd of plasma to create 3 mL of platelets concentrate of 3-5 times 
higher than basal and injected within one hour of preparation (11). During early-mid follicular 
phase, using TV-US guidance and conscious sedation, 1.5 ml of PRP was injected into each 
ovary’s subcortical layer using a 17-gauge ovum pick-up needle. A second PRP injection was 
administered when subsequent ORTs (AMH,AFC) and hormone levels (FSH, LH, E2) showed 
suboptimal results in  patient’s next menstrual cycles.    
The role  of Ovarian PRP Therapy in Poseidon Poor Responders Women undergoing ICSI Cycle. 22/9/2025  

2.4. ICSI cycle outcomes  
 All patients starting same COS protocol began on CD3 using (300-450 iu) of Gonal-F (r-FSH); 
Merck ± (u-HMG);LG in flexible antagonist protocol, (Cetrotide); Merck. Final oocyte 
maturation was triggered by 250 mcg r-hCG (Ovitrelle; Serono) ± 0.2 mg GnRH agonist 
(Decapeptyl; Merck) 35 hours before oocyte retrieval when dominant follicles reached (17–18) 
mm. Embryological outcomes including;  MII oocytes, embryos quantity and quality were 
compared in both group. In all embryo transfer cycles, 2–4 embryos grade A± B of age 2–5 day 
were transferred. The clinical outcomes included pregnancy rate (serum β-HCG ≥100 mIU/mL),  
miscarriage rate (the loss of a pregnancy before 24 weeks), Live Birth rates (delivery of a living 
baby after 24 weeks) and overall cycle outcomes were compared in both groups.  
2.5. Statistical Analysis  
The collected data were coded, entered, and analyzed using IBM SPSS version 29 (IBM Corp., 
Chicago, IL, USA).  The data were presented as frequencies, percentages, means, standard 
deviations, and ranges. Comparisons between means of quantitative data were conducted using 
the independent Student’s t-test. Differences in proportions (qualitative data) were assessed using 
Pearson’s Chi-square test, with Yates’ correction or Fisher’s Exact test applied where 
appropriate. Statistical significance was defined as a p-value ≤0.05. 
 
 
 
 
 
 
 
 
The role  of Ovarian PRP Therapy in Poseidon Poor Responders Women undergoing ICSI Cycle. 22/9/2025