Evaluation of intraovarian injection of platelet-rich plasma for enhanced ovarian function and reproductive success in women with POI and POR: a systematic review and meta-analysis.

Abstract

Objective: The objective of this study was to evaluate the effect of the intraovarian injection of platelet-rich plasma (PRP) on ovarian reserve and reproductive outcomes in patients with premature ovarian insufficiency (POI) and poor ovarian response (POR).

Methods and data sources: The study registered in the PROSPERO database adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. PubMed, Web of Science, Scopus, Google Scholar, and ClinicalTrials.gov databases were searched from inception to June 2024-23 studies included in the meta-analysis. A total of 1853 participants aged 29.8-45 years old were included in the meta-analysis. The human studies reporting the effect of intraovarian PRP injection on ovarian reserve indicators were included in the meta-analysis. The quality of the included studies was assessed using the Cochrane Handbook or the Newcastle-Ottawa scale. The primary outcomes were serum levels of anti-Mullerian hormone (AMH), follicle-stimulating hormone (FSH), luteinizing hormone (LH), Estradiol, and antral follicle count (AFC), number of retrieved oocytes, metaphase II (M2) oocytes, and pregnancy and live birth rates.

Result(s): The pooled analysis of the included studies showed that intraovarian PRP injection significantly increased oocyte number (WMD: 0.97, 95% CI 0.58, 1.35, P < 0.001), M2 oocyte number (WMD: 0.80, 95% CI 0.33, 1.27, P < 0.001), AFC (WMD: 1.64, 95% CI 0.90, 2.38, P < 0.001), and AMH levels (WMD: 0.12 ng/mL, 95% CI 0.07, 0.17, P < 0.001) in women with POR. Besides, in women with POI, PRP injection significantly improved AFC (WMD: 1.33, 95% CI 1.19, 1.47, P < 0.001) and serum levels of FSH (WMD: - 15.68 IU/mL, 95% CI - 24.12, - 7.24, P < 0.001), AMH (WMD: 0.29 ng/mL, 95% CI 0.08, 0.49, P = 0.006), and LH (WMD: - 9.87 IU/mL, 95% CI - 15.23, - 4.51, P < 0.001). The meta-analysis revealed a pregnancy ratio of 0.21 and a live birth ratio of 0.18 in women with poor ovarian reserve after PRP injection. In women with POI, the figures were marginally lower, recorded as 0.138 for pregnancy and 0.10 for live birth, respectively.

Conclusion: PRP may serve as an alternative therapy for POI and POR; however, further investigation is required to validate its efficacy and determine suitable candidates.