Platelet-rich plasma in poor responder management

Poor responders are defined as 9-24% of women undergoing in vitro fertilization (IVF) who do not respond well to controlled ovarian stimulation protocols. The approach and treatment of these patients is still a controversial subject in IVF. Different ovarian stimulation protocols have been assessed in terms of increase the number of oocytes retrieved and the clinical outcome. Similarly, alternative therapeutic managements such as growth hormone, testosterone, ASA and so forth have been evaluated to improve the pregnancy outcome. Recently, Autologous (PRP) has been widely applied for numerous medical conditions without main complications. PRP is a high-concentrated of autologous human platelets comprising different kinds of adhesion molecules, cytokines, chemokines, coagulation factors, integrins, and growth factors. These elements induce cell proliferation, differentiation, and migration, angiogenesis, as well as extracellular matrix remodeling and tissue regeneration.In the cases of ovarian failure in animals preliminary results of using Autologous platelet rich plasma (PRP) are encouraging. There are reports of successful pregnancies in cases of recurrent implantation failure and premature menopause after PRP treatment.For the first time in human, three poor responder women with the history of IVF failure, poor oocyte and embryo quality were treated using multifocal intramedullary plus subcortical layers diffusion of PRP. The treatment resulted in two 17 and 24-week pregnant women and a successful live-birth (Sfakianoudis et al, 2019). In the same way, Farimani et al performed PRP injection into each ovary of 19 women underwent ovarian stimulation. The mean oocyte numbers was improved after PRP injection. Two women conceived spontaneous pregnancy and one case achieved clinical pregnancy and delivered a healthy baby girl (Farimani et al, 2019). A research project has been started in Yazd Reproductive Sciences Institute on 24 poor responder women and patients with premature ovarian failure (POF). The preliminary results showed Anti-Mullerian hormone elevation in two poor responder women and two POF patients after up to two PRP injections. Furthermore, one poor responder women achieved chemical pregnancy subsequent one administration of PRP. In addition one woman with ovarian failure experienced menstruation after second PRP injection. The final results may be published in future. It seems that PRP treatment could be effectively administered as an alternative successful and safe approach in the cases of poor responders due to improve ovarian infusion and functionality.