Platelet Rich-Plasma Injections & Boosting Egg Count

 

““Very few studies have investigated the potential applicability of PRP in ovarian tissue regeneration.””

This is the first controlled study of women with low ovarian reserve using platelet-rich plasma (aka “PRP”) to improve low ovarian reserve or pregnancy outcomes. Before this study, there was evidence that PRP can heal and regenerate tissue in various parts of the body, but its use in ovaries for fertility was still largely unknown.

Study Background

WHERE

• one fertility clinic in Venezuela’s capital, Caracas.

WHO

• Inclusion criteria: at least 38 years old, baseline follicle-stimulating hormone (FSH) level on day 3 of > 12 mIU/mL, baseline anti-Müllerian hormone (AMH) < 0.8 ng/mL, and a normal uterine cavity. 

• Exclusion criteria: polycystic ovary syndrome (PCOS), endometriosis, a history of pelvic inflammatory disease, infertility due to tubal factors, platelet disorders, or male factor infertility. 

• Women chose whether or not to be in the intervention group (PRP) or the control group (no PRP).

HOW

• Complete (whole) blood was collected on the ovary injection date

• Via centrifuge, plasma and platelets rise were separated from red blood cells following centrifuge.  

• Women were sedated, then an ultrasound guided the needle containing PRP into the ovary

• After three months of injections, FSH, AMH and AFC measurements were repeated

Once treatment was completed with PRP, participants tried to conceive via IVF/ICSI, IUI, or via stimulation medications paired with timed intercourse.

Study Results

See Fig 1 below. Of the 83 women included, 46 received PRP and 37 in the control group did not. There were no significant underlying differences (age, baseline ovarian markers, etc.) between the two groups. After the three-months of PRP injections, the PRP group’s results showed:

• better markers of ovarian reserve (higher AMH levels, lower FSH levels, and more antral follicles)

• higher number of oocytes (1.5x) if also utilizing IVF/ICSI

• higher rates of pregnancy (biochemical and clinical)

• same rates of first trimester miscarriage

• same rates of live birth

• no adverse affects associated with PRP injections

Overall Assessment

Study Strengths

1) These authors were knowledgeable - they did their homework and looked at the few case reports on PRP injections that had been completed before their work, which helped them to tweak their study. 

2) The data seemed reliable, because the authors had collected over twelve months of data on all of the test participants (and no participants were lost to follow up). 

Study Weaknesses

1) This study was conducted at one fertility clinic. While having all data and procedures done at one site may have decreased the variability of the testing processes (because they used the same ultrasound equipment and the same lab assays), it’s unclear if their results can be easily replicated in other fertility clinics.

2) This wasn’t randomized - the women in the study knew they if they were receiving PRP, as did their healthcare providers. These women were actually paying to be in the intervention group with PRP! This could have introduced (unintentional) bias in how the women in the two different groups were treated.

3) Though larger than any prior study testing PRP in ovaries, the size of this study was still too small to tell if there is a meaningful difference in the rates of clinical pregnancy rate, miscarriage, and live birth.

Conclusion

PRP shows promise in women with low ovarian reserve, and more evidence is needed to feel confident about widely adding them to fertility treatment plans.

Additional Resources

• A California fertility clinic has trademarked a technique for injecting PRP into women’s ovaries. Given what you know now about PRP injections, it might be worth exploring if this could help you!

  https://cagivf.com/ovarian-rejuvenation-prp/

• Dawood AS and Salem HA. Current clinical applications of platelet-rich plasma in various gynecological disorders: An appraisal of theory and practice 2018 Jun; 45(2): 67–74. Clin Exp Reprod Med. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6030616/

• Melo P., Navarro C, Jones C. et al. 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). https://doi.org/10.1007/s10815-020-01710-z