Context

The effect of platelet-rich plasma (PRP) on ovarian reserve markers in poor ovarian response (POR) is challenging.

Aim

This systematic review and meta-analysis was, therefore, designed to evaluate the effectiveness of intra-ovarian injection of autologous PRP on improving ovarian reserve markers and assisted reproductive technology (ART) outcomes in infertile women with POR.

Methods

A systematic search was conducted for the efficacy of intra-ovarian injection of autologous PRP on the improvement of ovarian reserve markers and ART outcomes in infertile women with POR. The methodological quality of the included studies was checked and eligible studies were included in the meta-analysis to find pooled results. Keywords were primary ovarian insufficiency, premature menopause, poor responder, poor ovarian response, diminished/decreased ovarian reserve, platelet-rich plasma, and intra-ovarian or a combination of them. The effect of PRP on fertility indices was evaluated using the standardized mean difference (SMD). The analysis was performed through STATA version 13.

Key results

13 studies containing 1289 patients were included. Mean age, body mass index (BMI) and duration of infertility was 37.63 ± 2.66 years, 24 ± 1.23 kg/m² and 4.79 ± 1.64 years, respectively. Most of the studies measured the outcomes 2–3/3 months after intra-ovarian injection of autologous PRP. The antral follicular count (AFC) after treatment by PRP is higher with an SMD of 0.95 compared to before treatment. The day 3 follicle-stimulating hormone (FSH) after treatment by PRP is lower with an SMD of − 0.25 compared to before treatment. The day 3 estradiol (E2) after treatment by PRP is higher with an SMD of 0.17 compared to before treatment. The anti-Mullerian hormone (AMH) after treatment by PRP is higher with an SMD of 0.44 compared to before treatment. The total oocytes number after treatment by PRP is higher with an SMD of 0.73 compared to before treatment. The number of MII oocytes after treatment by PRP is higher with an SMD of 0.63 compared to before treatment. The number of cleavage-stage embryos after treatment by PRP is higher with an SMD of 1.31 compared to before treatment. The number of day 5 embryo after treatment by PRP is higher with an SMD of 1.28 compared to before treatment. Pooled estimation of a meta-analysis of prevalence studies reported a prevalence of 22% for clinical pregnancy, 5% for spontaneous pregnancy and 21% for ongoing pregnancy following PRP therapy.

Conclusion

Intra-ovarian injection of PRP improved ovarian reserve markers with increasing AFC, serum level of AMH and day 3 E2 and decreasing serum level of day 3 FSH. In addition, this treatment improved ART outcomes through the increasing of number total oocytes, number of MII oocytes, number of cleavage-stage embryos and number of day 5 embryos in POR women.

Implications

Although treatment of POR women remains challenging, the use of intra-ovarian injection of autologous PRP in POR patients prior to IVF/ICSI cycles is a sign of new hope for increasing the success of IVF/ICSI. However, further well-organized, randomized controlled trials should be conducted to substantiate this result and recommend intra-ovarian injection of PRP as part of routine treatment in women with POR.

中文翻译：

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卵巢内注射自体富血小板血浆对反应不佳的女性的疗效：系统评价和荟萃分析

语境

富含血小板血浆（PRP）对卵巢反应不良（POR）中卵巢储备标志物的影响具有挑战性。

目的

因此，这项系统评价和荟萃分析旨在评估卵巢内注射自体 PRP 对改善 POR 不孕女性卵巢储备标志物和辅助生殖技术 (ART) 结局的有效性。

方法

对卵巢内注射自体 PRP 对改善 POR 不孕女性卵巢储备标志物和 ART 结局的功效进行了系统研究。检查纳入研究的方法学质量，并将符合条件的研究纳入荟萃分析以查找汇总结果。关键词是原发性卵巢功能不全、过早绝经、反应差、卵巢反应差、卵巢储备减少/减少、富含血小板的血浆、卵巢内或它们的组合。使用标准化均差（SMD）评估 PRP 对生育指数的影响。通过 STATA 版本 13 进行分析。

主要成果

纳入了 13 项研究，涉及 1289 名患者。平均年龄、体重指数（BMI）和不孕持续时间分别为37.63±2.66岁、24±1.23kg/m ²和4.79±1.64岁。大多数研究在卵巢内注射自体 PRP 后 2-3/3 个月测量结果。与治疗前相比，PRP 治疗后的窦卵泡计数 (AFC) 更高，SMD 为 0.95。与治疗前相比，PRP 治疗后第 3 天的卵泡刺激素 (FSH) 较低，SMD 为 − 0.25。与治疗前相比，PRP 治疗后第 3 天的雌二醇 (E2) 较高，SMD 为 0.17。 PRP治疗后的抗苗勒管激素（AMH）较治疗前更高，SMD为0.44。与治疗前相比，PRP 治疗后的卵母细胞总数更高，SMD 为 0.73。 PRP 处理后的 MII 卵母细胞数量比处理前更高，SMD 为 0.63。 PRP处理后的卵裂期胚胎数量比处理前更高，SMD为1.31。与治疗前相比，PRP 治疗后第 5 天胚胎的数量更高，SMD 为 1.28。对患病率研究的荟萃分析的汇总估计报告显示，PRP 治疗后临床妊娠的患病率为 22%，自然妊娠的患病率为 5%，持续妊娠的患病率为 21%。

结论

卵巢内注射 PRP 改善了卵巢储备标志物，增加了 AFC、AMH 和第 3 天 E2 的血清水平，并降低了第 3 天 FSH 的血清水平。此外，这种治疗通过增加 POR 女性的卵母细胞总数、MII 卵母细胞数量、卵裂期胚胎数量和第 5 天胚胎数量来改善 ART 结局。

影响

尽管 POR 女性的治疗仍然具有挑战性，但在 IVF/ICSI 周期之前对 POR 患者进行卵巢内注射自体 PRP 是提高 IVF/ICSI 成功率的新希望。然而，应进行进一步组织良好的随机对照试验来证实这一结果，并建议卵巢内注射 PRP 作为 POR 女性常规治疗的一部分。