Effect of intra-ovarian injection of platelet-rich plasma on the patients with a poor ovarian response (POR) or premature ovarian insufficiency (POI): a systematic review and meta-analysis

Abstract

Abstract Background POR or POI poses a significant challenge to fertility treatment with different ovarian stimulation strategies. Intra-ovarian injection of platelet-rich plasma (PRP) has been hypothesised to improve ovarian reserve and pregnancies in POI or POR. However, its effectiveness on pregnancy, embryology and ovarian reserve outcomes need to be established. Therefore, we systematically searched databases based on PRISMA guidelines that reported on the effects of intra-ovarian autologous PRP injections in sub-fertile women with POI and POR. The following outcome effects were analysed by random model and included in the meta-analysis in pre- and post-PRP injection groups of POI & POR: (a) pregnancy rates, rate of oocyte & embryo formation (b) ovarian reserve markers (Antral follicular count, Anti-Mullerian Hormone, Follicle Stimulating Hormone). A separate analysis of pregnancies, AFC and AMH was done in POI and POR groups and in age groups 35 years. A total of 12 studies were included. The estimated overall effects size of the log odds ratio (log OR = 2.03; 95% CI = 0.13 to 3.92; P = 0.04; I2 = 0.42) favoured post-PRP with a moderate level of evidence. There are no significant differences in POI/POR and those with 35 years. The pooled standard difference of means favoured the post-PRP injection group significantly with regards to rates of embryo formation (1.39; 95% CI = 0.56 to 2.21; P = 0.02; I2 = 46%.), Oocyte (0.84; 95% CI = -1.3 to 3.0; P = 0.24; I 2 93%), Antral follicle count (1.78; 95% CI = 0.73 to 2.84; P = 0.01. I2 = 97%) with a low level of evidence and Anti-Mullerian Hormone (1.11; 95% CI = 0.16 to 2.05; P = 0.03; I2 = 96%) with low level of evidence. Conclusion Our study shows that intraovarian PRP injection was associated with no significant increase in the rates of pregnancy, in the rates of pregnancy, oocyte, embryo formation, Anti-Mullerian Hormone and antral follicle count. Live birth rates were not calculated. There was no statistical difference between POR/POI and those with 35 years. Further randomized studies are warranted to confirm our findings.

Keywords

• Platelet-rich plasma
• Ovarian rejuvenation
• Premature ovarian insufficiency
• Pregnancy
• In-vitro fertilization (IVF)
• Intracytoplasmic sperm injection (ICSI)