The efficacy of platelet rich plasma on women with poor ovarian response: a systematic review and meta-analysis

Figures & data

Figure 1. Literature search flowchart of study selection.

Table I. Characteristics of included studies.

Characteristics of included studies
Study	Country	Population	Age	Sample size	Intervention(s)	Time of PRP infusion	PRP activated or not	Outcome measures
Navali et al.^Citation18	Iran	POR	40.68 ± 0.34	35	About 2 cc of autologous obtained PRP injected into the cortex of both ovaries	after oocyte pick up	N	pregnancy outcome, the number of oocytes, antral follicles, and level of estradiol, AMH, FSH, LH, FSH/LH ratio
Keikha et al.^Citation19	Iran	POR (Bologna)	40.40 ± 3.91	12	Four cc of aPRP was multifocal intramedullary injected into the right ovary	after the Oocytes Pick-Up	N	AMH, FSH level, dominant follicles, MII mature oocytes, available embryos
Pacu et al.^Citation20	Romania	POR (POSEIDON)	37.40 ± 4.69	20	The injection was performed with 2–4 ml PRP at the level of the ovarian parenchyma	between days 3–5 of the menstrual cycle	N	pregnancy outcome, FSH, LH, AMH, AFC, the number of MII oocytes and good quality embryos
Farimani et al.^Citation21	Iran	POR (POSEIDON)	38.30 ± 4.53	96	The intra-ovarian PRP injection (2 ml) was performed under ultrasound guide	right after the first follicular puncture	N	pregnancy outcome, AMH, LH, FSH, and estradiol levels; The number of oocytes(total, MI, MII, and GV)
Cakiroglu et al.^Citation22	Turkey	POR (POSEIDON)	40.30 ± 4.00	510	PRP was injected into at least one ovary transvaginally under ultrasound guidance	within 10 days after completion of menstrual bleeding	N	spontaneous pregnancies; ovarian reserve assessment (Antral follicle count, FSH, and AMH; IVF outcome
Tülek et al.^Citation23	Turkey	POR (Bologna)	38.10 ± 4.40	50	2 mL of solution was injected into the stromal region of each ovary	/	N	live birth delivery rates; number of retrieved oocytes, 2 pronuclear embryos and cleavage stage embryos
Aflatoonian et al.^Citation24	Iran	POR (Bologna)	33.66 ± 4.84	17	The multifocal intramedullary infusion of 1.5 ml activated PRP was performed into each ovary. The second PRP injection with the twofold increase in the dosage to 3 ml, 3 months after the first injection.	10 days after the beginning of menstrual bleeding	Y	AMH, FSH, LH, E2; pregnancy outcome
Sfakianoudis et al.^Citation25	Greece	POR (Bologna)	38.40 ± 2.01	30	Across the central part of each ovary respectively, and thereafter gradual infusion of 4 mL of activated PRP, via a syringe attached to the transvaginal probe transducer.	performed at least 2 months following the last ICSI-ET cycle	Y	pregnancy outcome, levels of AMH, AFC and oocyte yield
Parvanov et al.^Citation26	Bulgaria	POR (Bologna)	40.50 ± 4.00	66	The activated PRP was slowly introduced during careful retraction of the needle across the previously traversed ovarian cortex	between day 7 and day 11 of the menstrual cycle for two consecutive cycles	Y	AFC, FSH, AMH, fertilization rate, number and quality of oocytes and embryos.
Stojkovska et al.^Citation27	Republic of Macedonia	POR (Bologna)	37.47 ± 3.87	40	After activation, approximately 3–5 ml of the PRP was injected into the ovaries under transvaginal ultrasound guidance	/	Y	hormones FSH, estradiol, AMH, number of antral follicles

Figure 2. Forest plot of live birth rate (A) and clinical pregnancy rate (B).

Figure 3. Forest plot of oocytes (A), embryos (B) and AFC (C).

Figure 4. Forest plot of AMH level.

Figure 5. Forest plot of FSH level.

Figure 6. Forest plot of LH level.

Navali N, Sadeghi L, Farzadi L, Ghasemzadeh A, Hamdi K, Hakimi P, Niknafs B. Intraovarian injection of autologous platelet-rich plasma improves therapeutic approaches in the patients with poor ovarian response: a before-after study. Int J Fertil Steril. 2022;16(2):90–94. doi:10.22074/IJFS.2021.533576.1154.

 PubMed Web of Science ®Google Scholar

Keikha F, Shahsavari S, Salari Y, Roozbeh N, Haghollahi F, Tarazjani MD, Razavi M, Shariat M, Bagheri M. One side ovarian rejuvenation: a quasi-experimental study of the effect of the autologous platelet rich plasma in poor ovarian responders in IVF. Ethiop J Health Sci. 2022;32(6):1133–1140. doi:10.4314/ejhs.v32i6.10.

 PubMed Web of Science ®Google Scholar

Pacu I, Zygouropoulos N, Dimitriu M, Rosu G, Ionescu CA. Use of platelet-rich plasma in the treatment of infertility in poor responders in assisted human reproduction procedures. Exp Ther Med. 2021;22(6):1412. doi:10.3892/etm.2021.10848.

 PubMed Web of Science ®Google Scholar

Farimani M, Nazari A, Mohammadi S, Anvari Aliabad R. Evaluation of intra-ovarian platelet-rich plasma administration on oocytes-dependent variables in patients with poor ovarian response: a retrospective study according to the POSEIDON criteria. Reprod Biol Endocrinol. 2021;19(1):137. doi:10.1186/s12958-021-00826-w.

 PubMed Web of Science ®Google Scholar

Cakiroglu Y, Yuceturk A, Karaosmanoglu O, Kopuk SY, Korun ZEU, Herlihy N, Scott RT, Tiras B, Seli E. Ovarian reserve parameters and IVF outcomes in 510 women with poor ovarian response (POR) treated with intraovarian injection of autologous platelet rich plasma (PRP). Aging. 2022;14(6):2513–2523. doi:10.18632/aging.203972.

 PubMedGoogle Scholar

Tülek F, Kahraman A. The effects of intra-ovarian autologous platelet rich plasma injection on IVF outcomes of poor responder women and women with premature ovarian insufficiency. J Turkish German Gynecol Assoc. 2022;23(1):14–21. doi:10.4274/jtgga.galenos.2021.2021.0134.

 PubMed Web of Science ®Google Scholar

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 (Thousand Oaks, Calif). 2021;28(7):2050–2059. doi:10.1007/s43032-021-00483-9.

 PubMed Web of Science ®Google Scholar

Sfakianoudis K, Simopoulou M, Grigoriadis S, Pantou A, Tsioulou P, Maziotis E, Rapani A, Giannelou P, Nitsos N, Kokkali G, et al. Reactivating ovarian function through autologous platelet-rich plasma intraovarian infusion: Pilot data on premature ovarian insufficiency, perimenopausal, menopausal, and poor responder women. J Clin Med. 2020;9(6):1809. doi:10.3390/jcm9061809.

 PubMed Web of Science ®Google Scholar

Parvanov D, Ganeva R, Vidolova N, Nikolova K, Vasileva M, Totev T, Stamenov G. Autologous ovarian platelet rich plasma treatment improves oocyte and embryo quality: a before-after prospective study. Biotechnol Biotechnol Equip. 2022;36(1):425–32. doi:10.1080/13102818.2022.2090280.

 Web of Science ®Google Scholar

Stojkovska S, Dimitrov G, Stamenkovska N, Hadzi-Lega M, Petanovski Z. Live birth rates in poor responders’ group after previous treatment with autologous platelet-rich plasma and low dose ovarian stimulation compared with poor responders used only low dose ovarian stimulation before in vitro fertilization. Open Access Maced J Med Sci. 2019;7(19):3184–8. doi:10.3889/oamjms.2019.825.

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