Intra-ovarian Platelet-Rich Plasma Administration Plus Successive Accumulated Embryo Transfer Could Be a Promising Strategy for Poor Ovarian Response Management: a Retrospective Cohort Study

Study question Does intra-ovarian injection of platelet-rich plasma (PRP) plus successive accumulated embryo transfer improve the outcome of Patients with Poor Ovarian Response (POR)? Summary answer Intra-ovarian injection of PRP plus successive embryo accumulation following mild stimulation and accumulated embryo transfer appears to be a optimal strategy for POR management. What is known already The treatment of poor responders is a challenge for both patients and clinicians. Various protocols have been adopted in attempts to increase the pregnancy rates in patients with POR; however, the outcomes of these strategies are disappointing. Alternatives are needed. A handful of clinical datas have reported promising results of the use of PRP injections into the ovary. In addition, some clinical evidence proved that embryo accumulation following mild stimulation appears to be an optimal strategy for POR management. However, limited knowledge is available on the effect of the combination of intra-ovarian injection of PRP and accumulated embryo transfer strategy. Study design, size, duration This single-center retrospective study has been performed from May 2021 to May 2022. Using the POSEIDON criteria, 13 group 3 and 36 group 4 POR women undergone intra-ovarian PRP injection combined with accumulation of embryos through 3 successive mild stimulation IVF (ICSI) cycles before transfer. Participants/materials, setting, methods POR Women (AMH<1.2ng/ml) who have undergone intra-ovarian PRP injection and followed by accumulation of embryos through 3 successive mild stimulation IVF (ICSI) cycles before transfer were eligible. According to the POSEIDON criteria, 49 women were included. The primary outcomes were Clinical pregnancy and cancelled cycles. The helpful variables (LH, FSH, AMH, estradiol and AFC) and embryology outcomes of IVF (ICSI) cycles were also collected. Main results and the role of chance The mean age of all participants was 37.67±4.15 years and their mean body mass index was 21.52±2.80 kg/m2. Autologous intraovarian PRP therapy significantly increased AMH levels (0.41±0.05ng/mL vs 0.65±0.13ng/mL, P = 0.035), AFC (2.02±0.19 vs 2.94±0.21, P = 0.0013) and decreased FSH (14.57±1.14 IU/L vs 11.42±0.81IU/L, P = 0.03). Autologous intraovarian PRP therapy accompanied with 3 successive cumulated cycles, significantly increased No. of accumulated embryos (0.46±0.08 vs 1.61±0.17, P < 0.0001) and blastocysts (0.04±0.03 vs 0.92±0.14, P < 0.0001). Also, intra-ovarian injection of PRP plus successive embryo accumulation strategy significantly reduced the rate of cancelled cycle (57.13% (28/49) vs 10.2% (5/49), P < 0.0001). Following this stategy, of 44 cases with accumulated embryos/blastocysts transfer, 20 (45.45%) got clinical pregnant. Limitations, reasons for caution The study was small samples and retrospective, without randomization. In addition, the ongoing pregnancy or live birth may reflect the effect much better. Wider implications of the findings Intra-ovarian injection of PRP plus successive embryo accumulation strategy significantly reduced the risk of cancelled cycle in POR; the clinical pregnant rate is about 45%. It could be the optimal strategy for POR management. Further studies are needed to verify these conclusions and the exact mechanisms of PRP. Trial registration number not applicable