O-224 Effect of intraovarian injection of platelet rich plasma on ovarian response in poor responder women
Authors: Fuentes A , Castillo J C , Moliner B , García-Ajofrín C , Martínez M , Suñol J , Gavilán C , Luque L , Buccheri M , Ortíz J A , Fabregat A M , Bernabeu R , Bernabeu A 
Published: June 2023

Abstract

Study question
Does intraovarian administration of platelet rich-plasma (PRP) increase ovarian response in women with poor ovarian response (POR) undergoing IVF treatment?

Summary answer
In patients with low ovarian response, the number of oocytes and embryos is higher in the 4 cycles after PRP administration compared to pre-PRP cycles.

What is known already
The number of oocytes after controlled ovarian stimulation is a crucial factor in IVF outcomes. For this reason, different approaches have been investigated for the management of patients with POR, such as the administration of adjuvant treatments, or the change of protocol, dose or type of gonadotropin. However, none of these strategies has proven to be fully effective in improving oocyte yield.
More recently, innovative treatments aimed at activating preantral follicles have emerged, such as intraovarian administration of autologous platelet rich plasma (PRP). Although the evidence is still limited, some studies suggest an improvement in ovarian response following PRP treatment.

Study design, size, duration
Retrospective study of 83 patients diagnosed with low ovarian reserve according to Bologna criteria who underwent intraovarian PRP between July 2021 and December 2022. 111 stimulation cycles after PRP were compared with the cycles immediately prior to PRP administration.

Participants/materials, setting, methods
Patients with POR were presented with an oocyte or embryo preservation strategy, which included the option of administering intraovarian platelet-rich plasma (PRP) either during the initial oocyte retrieval or in the follicular phase of the cycle preceding stimulation. A 2 ml dose of PRP was administered into each ovary. The ovarian response was analyzed in terms of the number of oocytes, MII, and embryos, and was further evaluated based on different age groups.

Main results and the role of chance
83 women (age: 38,68 ± 3,54, range 28-46 years) underwent a PRP injection. The patients had low ovarian reserve markers (AMH 2,90 ± 2,76 pmol/l, AFC 4,74 ± 2,70).
Of the cycles after PRP, 48 were performed in the luteal phase of the same cycle, 28 in the follicular phase of the first post-PRP cycle and 35 between the 2nd and 4th cycle post PRP.
The overall mean number of oocytes (2,38 ± 2,09 vs. 3,19 ± 2,70; p = 0,002) and MII (1.84 ± 1.77 vs. 2.54 ± 2.25, p = 0.0008) was significantly higher after PRP. There was also a statistically significant difference in the number of blastocysts pre and post PRP (0,85 ± 1,12 vs. 1,77 ± 1,89; p = 0,0005). There were no differences in the blastulation or euploidy rates.
Differences in the number of oocytes were not observed in the luteal phase cycle (2.97 ± 2.35 vs. 3.45 ± 2.66, p = 0.2) compared to the subsequent 1st-4th cycles (1.88 ± 1.77 vs. 2.95 ± 2.73, p = 0.003).
Improvement in response was observed in patients younger than 40 years (2 ± 1.52 vs 3.3 ± 2.62 oocytes; p = 0.0002), but not in patients aged ≥ 40 years (2.9 ± 2.58 vs 3.02 ± 2.77 oocytes; p = 0.7).

Limitations, reasons for caution
The retrospective nature of the study is a significant limitation. As this research is based on real-world clinical practice, the patientś stimulation protocols were diverse which may have impacted the results. To verify our findings, further studies with a uniform control group are required.

Wider implications of the findings
We observed improved response to intraovarian platelet-rich plasma administration in patients with POR under 40 years of age. This enhancement was observed from the initial follicular cycle following administration. Our findings suggest that intraovarian PRP may be a valuable supplementary treatment for this patient population.

Trial registration number
not applicable