Intraovarian Injection of Platelet-rich Plasma in Assisted Reproduction: Too Much too Soon?

Lloyd Atkinson; Francesca Martin; Roger G. Sturmey

Disclosures

Hum Reprod. 2021;36(7):1737-1750. 

In This Article

Conclusions and Future Prospects

Even though there are other biological derivatives, such as human umbilical cord plasma, which may provide additional benefits in the sphere of ART (de Miguel-Gómez et al., 2020), the appeal of PRP lies in its balance among therapeutic effect, cost effectiveness, ease of isolation and autologous nature. However, with the increased interest of ovarian PRP injection inconclusive efficacy and lack of understanding of mechanism of action, fundamental research into the effect of this therapy on the cellular level is required. Dysregulation of early processes in oocyte maturation and subsequent embryo development can lead to drastic changes in the growing foetus, possibly leading to increased risk of disease in early years and onwards. Indeed, the long-term safety of new treatments in ART must be robustly assessed (Harper et al., 2012), especially given the context that there is still concern that ART itself may increase the risk of birth defects (Luke et al., 2020). Perhaps most of most relevance in the context of PRP, the precise physiological causes of premature ovarian failure or primary ovarian insufficiency outside the natural ageing process remain poorly understood, and further work to understand the role of putative OSCs is required.

With ovarian PRP therapy in its infancy, understandably, there is poor standardisation among research groups and clinics, however, this must soon be addressed to form a consensus as to the efficacy of this treatment. To assist this, we would propose that authors carrying out research in this area commit to reporting of key basic information regarding PRP. At a minimum, we suggest that such studies should include platelet count, activation status, activation agent (if any), platelet function testing, origin of PRP, volume infused, anticoagulant used, clinical account of menstrual status based on AMH level, and a detailed reporting of the participant's fertility history.

Additionally, while there are encouraging data supporting the notion that PRP treatment might have some future use in the ART setting, it is paramount that we undertake robust and detailed basic studies to understand mechanism of action and to try to identify unintended outcomes, before moving into whole animal studies. These precursors would be an important bedrock on which to carry out well-designed clinical studies, allowing us to investigate this new technology with all rigour currently available. There are, at the time of writing, 13 registered clinical trials investigating the effect of PRP on ovarian rejuvenation either recruiting or underway. Strikingly, few of these trials describe the inclusion of appropriate PRP controls. It is only from well-controlled trials, built on detailed mechanistic understanding that we can clarify the platelet-mediated effects of PRP therapy in ovarian rejuvenation and folliculogenesis.

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