A novel method of intraovarian instillation of platelet rich plasma to improve reproductive outcome in young Indian women with diminished ovarian reserve

Introduction: To evaluate the effects of intraovarian platelet-rich plasma (IOPRP) instillation in young Indian women with diminished ovarian reserve (DOR). Methods: This prospective, ongoing, cohort study was performed by recruiting 45 consenting Indian women with DOR (group A). Up to 3 cycles of IOPRP instillation were performed after minimal ovarian stimulation. Outcome measures were changes in antral follicle counts (AFC), anti-Müllerian hormone (AMH) levels, an increase in total and mature oocytes retrieved and establishment of pregnancy. The pregnancy rates in 51 women with the same inclusion criteria during the same time period were compared (group B). Results: In group A, baseline mean AFC was 3.44±2.35 (n=45); mean AFC increased after IOPRP-1 (3.89±2.21, n=45, P =0.1198<0.05 vs. baseline), IOPRP-2 (4.91±2.79, n=33, P =0.0056<0.05 vs. baseline), and IOPRP-3 (4.95±2.84, n=19, P =0.0002<0.05 vs. baseline). Mean AMH was 0.85±0.44 ng/mL. The changes in average AMH levels showed significance after IOPRP-2 ( P =0.048<0.05). In group B, mean baseline AFC was 4.74±2.19, mean baseline AMH was 0.98±0.38 ng/mL. In group A, frozen embryo transfer was performed in 32/45 women and 15 clinical pregnancies were established. In group B, 44/51 women underwent frozen embryo transfer, 11 clinical pregnancies were established. The clinical pregnancy rate per transfer was 46.88%/embryo transfer in group A versus 25%/embryo transfer in group B. Conclusions: IOPRP instillation can improve AFC and can enhance pregnancy results in women with DOR. Increase in AMH levels and the number of total and mature oocytes was observed after 2 IOPRP. Significantly higher pregnancy rates ( P =0.0009<0.05) were observed in women with IOPRP versus matched controls without IOPRP.