Unlocking ovarian rejuvenation with platelet-rich plasma: systematic review and proposed clinical framework for Controlled use in poor prognosis patients undergoing in vitro fertilisation.

BACKGROUND: Platelet-rich plasma (PRP) is used as an adjunctive treatment in various medical fields, including orthopaedics, plastic surgery, dermatology, and wound healing. However, PRP application in reproductive medicine, particularly for fertility restoration, remains controversial, specifically for women with diminished ovarian reserve (DOR), premature ovarian insufficiency (POI), and pre-menopause. This systematic review aimed to comprehensively evaluate the existing literature on autologous PRP use for ovarian rejuvenation, with a focus on refining and standardising PRP protocols and identifying appropriate candidate populations.
METHODS: A comprehensive literature search was conducted on the autologous PRP use using Cochrane, Embase, PubMed, MEDLINE, NCBI, and Google Scholar databases. Studies on PRP application in reproductive medicine were identified and classified into two categories: DOR and POI. The PRP preparation protocol was assessed, and the results were compared. This narrative systematic review, carried out in compliance with PRISMA 2020 guidelines, combined results, although meta-analysis was not feasible due to significant variation in study design, PRP preparation, and outcome measures.
RESULTS: Several studies reported restoration of menstruation following intraovarian PRP administration in women with POI. In women with DOR, studies reported changes in ovarian reserve markers, including increases in serum anti-Müllerian hormone (AMH) levels and reductions in follicle-stimulating hormone (FSH) levels; however, these changes were not consistently associated with higher antral follicle counts or oocyte yield. Instead, sseveral studies reported higher proportions of mature oocytes and pregnancy and live birth outcomes, particularly following repeated PRP treatment cycles in women with long-standing ovarian dysfunction.
CONCLUSIONS: Intraovarian PRP may have a potential role in activating dormant follicles in a selected subset of women with poor ovarian response. However, the current evidence remains limited and heterogeneous, supporting its use only within structured clinical or research protocols until higher-quality, standardised studies are available.