Intraovarian Injection of Autologous Platelet-Rich Plasma Improves Therapeutic Approaches in The Patients with Poor Ovarian Response: A Before-After Study

Document Type : Original Article


1 Women’s Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran

2 Department of Obstetrics and Gynecology, Alzahra Hospital, Tabriz University of Medical Sciences, Tabriz, Iran

3 Department of Reproductive Biology, Faculty of Advanced Medical Sciences, Tabriz University of Medical Science, Tabriz, Iran


Background: Advanced age is associated with a decline in the natural oocytes, low oocyte yield, and also increases the 
assisted reproductive technology (ART) failure rate, and consequently resulted in a pregnancy rate decrease. Platelet-rich 
plasma (PRP) is one of the proposed therapeutic strategies for women with poor ovarian response (POR). Because of the autologous source of PRP, the lowest risks of disease transmission, immunogenic and allergic reactions have been expected. This study aimed to evaluate the single-dose intraovarian injection of autologous PRP in poor ovarian reserve.
Materials and Methods: We conducted a clinical trial study in the Al-Zahra hospital and Milad Infertility Clinic, Tabriz, Iran (April and May, 2021). A total of thirty-five women with a POR and mean age 40.68 ± 0.34 enrolled in this study. After injection of autologous PRP into the ovaries, the number of oocytes, antral follicles, and level of estradiol, anti-Müllerian hormone (AMH), follicle-stimulating hormone (FSH), luteal hormone (LH), FSH/LH ratio also were evaluated while, these parameters were evaluated before PRP administration. 
Results: At the 2-month follow-up, women treated with PRP showed a significant elevation in the number of oocytes 
(3.68 ± 0.24, P=0.0043) and embryos (3.17 ± 0.14, P=0.0001), as well as in the estradiol levels (404.1 ± 16.76 vs. 237.7 ± 13.14, P=0.0003). 
Conclusion: Single PRP injection is effective and might be a promising therapeutic approach in the patients with POR to 
conceive with their own oocytes, although further evidence is required to assess the influence of PRP on the live birth rate.




1. Martin JA, Hamilton BE, Osterman MJK, Driscoll AK, Drake P. Births: final data for 2016. Natl Vital Stat Rep. 2018; 67(1): 1-55.
2. Vo TKC, Tanaka Y, Kawamura K. Ovarian rejuvenation using autologous platelet-rich plasma. Endocrines. 2021; 2(1): 15-27.
3. Broekmans FJ, Soules MR, Fauser BC. Ovarian aging: mechanisms and clinical consequences. Endocr Rev. 2009; 30(5): 465-493.
4. Fritz R, Jindal S. Reproductive aging and elective fertility preservation. J Ovarian Res. 2018; 11(1): 66.
5. Farimani M, Heshmati S, Poorolajal J, Bahmanzadeh M. A report on three live births in women with poor ovarian response following intra-ovarian injection of platelet-rich plasma (PRP). Mol Biol Rep. 
2019; 46(2): 1611-1616.
6. Giovanale V, Pulcinelli FM, Ralli E, Primiero FM, Caserta D. Poor responders in IVF: an update in therapy. Gynecol Endocrinol. 2015; 31(4): 253-257.
7. Reynolds KA, Boudoures AL, Chi MM, Wang Q, Moley KH. Adverse effects of obesity and/or high-fat diet on oocyte quality and metabolism are not reversible with resumption of regular diet in mice. Reprod Fertil Dev. 2015; 27(4): 716-724.
8. Oboni JB, Marques-Vidal P, Bastardot F, Vollenweider P, Waeber G. Impact of smoking on fertility and age of menopause: a populationbased assessment. BMJ Open. 2016; 6(11): e012015.
9. Meirow D, Biederman H, Anderson RA, Wallace WH. Toxicity of chemotherapy and radiation on female reproduction. Clin Obstet Gynecol. 2010; 53(4): 727-739.
10. Özcan P, Fıçıcıoğlu C, Kizilkale O, Yesiladali M, Tok OE, Ozkan F, et al. Can Coenzyme Q10 supplementation protect the ovarian reserve against oxidative damage? J Assist Reprod Genet. 2016; 33(9): 1223-1230. 
11. Bahadori MH, Sharami SH, Fakor F, Milani F, Pourmarzi D, DalilHeirati SF. Level of vitamin E in follicular fluid and serum and oocyte morphology and embryo quality in patients undergoing IVF treatment. J Family Reprod Health. 2017; 11(2): 74-81.
12. Showell MG, Mackenzie-Proctor R, Jordan V, Hart RJ. Antioxidants for female subfertility. Cochrane Database Syst Rev. 2020; 8(8): CD007807. 
13. Sánchez-González DJ, Méndez-Bolaina E, Trejo-Bahena NI. Platelet-rich plasma peptides: key for regeneration. Int J Pept. 2012; 2012: 532519.
14. Qian Y, Han Q, Chen W, Song J, Zhao X, Ouyang Y, et al. Platelet-rich plasma derived growth factors contribute to stem cell differentiation in musculoskeletal regeneration. Front Chem. 2017; 5: 89.
15. Amable PR, Carias RB, Teixeira MV, da Cruz Pacheco I, Corrêa do Amaral RJ, Granjeiro JM, et al. Platelet-rich plasma preparation for regenerative medicine: optimization and quantification of cytokines 
and growth factors. Stem Cell Res Ther. 2013; 4(3): 67.
16. Melo P, Navarro C, Jones C, Coward K, Coleman L. 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; 37(4): 855-863. 
17. Ranjbaran A, Nejabati HR, Ghasemnejad T, Latifi Z, Hamdi K, Hajipour H, et al. Follicular fluid levels of adrenomedullin 2, vascular endothelial growth factor and its soluble receptors are associated with ovarian response during ART cycles. Geburtshilfe Frauenheilkd. 2019; 79(1): 86-93.
18. Panda SR, Sachan S, Hota S. A systematic review evaluating the efficacy of intra-ovarian infusion of autologous platelet-rich plasma in patients with poor ovarian reserve or ovarian insufficiency. Cureus. 2020; 12(12): e12037.
19. Sills ES, Rickers NS, Li X, Palermo GD. First data on in vitro fertilization and blastocyst formation after intraovarian injection of calcium gluconate-activated autologous platelet rich plasma. Gynecol Endocrinol. 2018; 34(9): 756-760.
20. Hosseini L, Shirazi A, Naderi MM, Shams-Esfandabadi N, Borjian Boroujeni S, Sarvari A, et al. Platelet-rich plasma promotes the development of isolated human primordial and primary follicles to the preantral stage. Reprod Biomed Online. 2017; 35(4): 343-350. 
21. Cakiroglu Y, Saltik A, Yuceturk A, Karaosmanoglu O, Kopuk SY, Scott RT, et al. Effects of intraovarian injection of autologous platelet rich plasma on ovarian reserve and IVF outcome parameters in women with primary ovarian insufficiency. Aging (Albany NY). 2020; 12(11): 10211-10222. 
22. Aflatoonian A, Lotfi M, Saeed L, Tabibnejad N. Effects of intraovarian injection of autologous platelet-rich plasma on ovarian rejuvenation in poor responders and women with primary ovarian insufficiency. Reprod Sci. 2021; 28(7): 2050-2059.
23. Sfakianoudis K, Simopoulou M, Nitsos N, Rapani A, Pappas A, Pantou A, et al. Autologous platelet-rich plasma treatment enables pregnancy for a woman in premature menopause. J Clin Med. 2018; 8(1): 1. 
24. Ramaswamy Reddy SH, Reddy R, Babu NC, Ashok GN. Stemcell therapy and platelet-rich plasma in regenerative medicines: a review on pros and cons of the technologies. J Oral Maxillofac Pathol. 2018; 22(3): 367-374.
25. Krüger JP, Freymannx U, Vetterlein S, Neumann K, Endres M, Kaps C. Bioactive factors in platelet-rich plasma obtained by apheresis. Transfus Med Hemother. 2013; 40(6): 432-440.
26. Otsuka F, McTavish KJ, Shimasaki S. Integral role of GDF-9 and BMP-15 in ovarian function. Mol Reprod Dev. 2011; 78(1): 9-21.
27. Pantos K, Nitsos N, Kokkali G, Vaxevanoglou T, Markomichali C, Pantou A, et al. Ovarian rejuvenation and folliculogenesis reactivation in peri-menopausal women after autologous plateletrich plasma treatment. 2016. P-401. Availabale from: https://sa1s3. (07 Jul 2021).
28. Hsu CC, Hsu L, Hsu I, Chiu YJ, Dorjee S. Live birth in woman with premature ovarian insufficiency receiving ovarian administration  of platelet-rich plasma (PRP) in combination with gonadotropin: a case report. Front Endocrinol (Lausanne). 2020; 11: 50.