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Meta-Analysis
. 2024 May 17;17(1):104.
doi: 10.1186/s13048-024-01423-2.

Platelet-rich plasma (PRP) treatment of the ovaries significantly improves fertility parameters and reproductive outcomes in diminished ovarian reserve patients: a systematic review and meta-analysis

Máté Éliás  1 , Márton Kónya  1 , Zsófia Kekk  1 , Caner Turan  1 , Isabel Pinto Amorim das Virgens  1 , Réka Tóth  1 , Márton Keszthelyi  1 , Péter Hegyi  1   2   3 , Szabolcs Várbíró  1 , Miklós Sipos  4   5
Affiliations
Meta-Analysis

Platelet-rich plasma (PRP) treatment of the ovaries significantly improves fertility parameters and reproductive outcomes in diminished ovarian reserve patients: a systematic review and meta-analysis

Máté Éliás et al. J Ovarian Res. .

Abstract

Introduction: The incidence of infertility caused by diminished ovarian reserve has become a significant problem worldwide. The beneficial effect of PRP treatment of the ovaries has already been described, but the high-level evidence of its effectiveness has not yet been proven.

Materials and methods: A systematic search was performed in five databases, until March 12th, 2024. Both randomized and non-randomized studies that compared PRP treatment of the ovaries to self-control among women with diminished ovarian reserve were eligible for inclusion. Hormonal levels (Anti-Müllerian hormone (AMH), Follicle stimulating hormone (FSH), Luteinizing hormone (LH), Estradiol (E2), In-vitro fertilization parameters (Antral follicle count, oocyte, and embryo count), biochemical and spontaneous pregnancy and livebirth were measured.

Results: 38 eligible studies were identified reporting on 2256 women. The level of AMH rised, the level of FSH decreased significantly after the PRP treatment. AMH 1 month MD 0.20 (n = 856, p > 0.001, 95% CI: [0.12;0.28]), 2 months MD 0.26 (n = 910, p = 0.013, 95% CI: [0.07;0.44]), 3 months MD 0.36 (n = 881, p = 0.002,95% CI: [0.20;0.52]). FSH 1 month MD -10.20 (n = 796, p > 0.039, 95% CI: [-19.80;-0.61]), 2 months MD -7.02 (n = 910, p = 0.017, 95% CI: [-12.48; -1.57]), 3 months MD -8.87 (n = 809, p = 0.010, 95% CI: [-14.19; -3.55]). The antral follicle count elevated significantly MD 1.60 (n = 1418, p = < 0.001, 95% CI: [0.92; 2.27]). Significant improvement was observed in the number of retrieved oocytes MD 0.81 (n = 802, p = 0.002, 95% CI: [0.36; 1.26]), and embryos created MD 0.91 (n = 616, p = 0.001, 95% CI: [0.45;1.36]). The incidence of spontaneous pregnancy following PRP treatment showed a rate with a proportion of 0.07 (n = 1370, 95% CI: 0.04-0.12), the rate of biochemical pregnancy was 0.18 (n = 1800, 95% CI: 0.15-0.22), livebirth was 0.11 (n = 1482, 95% CI: 0.07-0.15).

Conclusions: Our meta-analysis showed that based on protocolized analysis of the widest scientific literature search to date, containing predominantly observational studies, PRP treatment resulted in a statistically significant improvement in the main fertility parameters of diminished ovarian reserve women. Further multicenter, randomized trials, with large patient numbers and a longer follow-up period are needed to certify our results and develop the most effective treatment protocol.

Keywords: DOR; Diminished ovarian reserve; POF; PRP; Platelet-rich plasma; Premature ovarian failure.

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Conflict of interest statement

The authors declare no competing interests.

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram of selection
Fig. 2
Fig. 2
Forest plot of AMH levels before- and after-treatment with PRP. 2A AMH level one month after the PRP. 2B AMH level 2 months after the PRP. 2C AMH level 3 months after the PRP. AMH Anti-Mullerian hormone, CI Confidence interval, SD Standard deviation, CT Controlled trial, obs Observational study, D1-8 Domain 1–8, JBI JBI Manual for Evidence Synthesis, ROBINS-I Risk Of Bias In Non-randomized Studies—of Interventions, SD Standard deviation. *Contains data which was measured after one or three months after the PRP treatment as well
Fig. 3
Fig. 3
Forest plot of FSH levels before- and after-treatment with PRP. 3A FSH level one month after the PRP. 3B FSH level 2 months after the PRP. 3C FSH level 3 months after the PRP. FSH Follicle-stimulating hormone, CI Confidence interval, SD Standard deviation, CT Controlled trial, obs Observational study, D1-8 Domain 1–8, JBI JBI Manual for Evidence Synthesis, ROBINS-I Risk Of Bias In Non-randomized Studies—of Interventions. *Contains data which was measured after one or three months after the PRP treatment as well
Fig. 4
Fig. 4
Forest plot of Estradiol levels before- and after-treatment with PRP. 4A Estradiol level one month after the PRP. 4B Estradiol level 2 months after the PRP. 4C Estradiol level 3 months after the PRP. 4D Mid-cycle estradiol level. CI Confidence interval, SD Standard deviation, CT Controlled trial, obs Observational study, D1-8 Domain 1–8, JBI JBI Manual for Evidence Synthesis, ROBINS-I Risk Of Bias In Non-randomized Studies—of Interventions. *Contains data which was measured after one or three months after the PRP treatment as well
Fig. 5
Fig. 5
Forest plot of fertility parameters before- and after-treatment with PRP. 5A AFC level after the PRP. 5B oocyte count after the PRP. 5C embryo count after the PRP. AFC antral follicle count, CI Confidence interval, SD Standard deviation, CT Controlled trial, obs Observational study, D1-8 Domain 1–8, JBI JBI Manual for Evidence Synthesis, ROBINS-I Risk Of Bias In Non-randomized Studies—of Interventions
Fig. 6
Fig. 6
Forest plot of Pregnancies and Livebirth after-treatment with PRP. 6A Biochemical pregnancies after the PRP. 6B Spontaneous pregnancies after the PRP. 6C Livebirths after the PRP. CI Confidence interval, D1-8 Domain 1–8
See this image and copyright information in PMC

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