Medical Director, Repromed, Adelaide, South Australia, Australia.
Department of Obstetrics Gynaecology and Reproductive Medicine, Flinders University, Adelaide, South Australia, Australia.
Aust N Z J Obstet Gynaecol. 2022 Oct;62(5):767-772. doi: 10.1111/ajo.13578. Epub 2022 Jun 21.
Infertility caused by poor oocyte quality is one of the most difficult areas to manage. While oocyte donation is an effective treatment, for most women it is a treatment of last resort. Ovarian platelet-rich plasma (PRP) treatment is a relatively new adjunct therapy which has been reported to possibly improve oocyte quality and in vitro fertilisation (IVF) treatment outcomes in women with severe diminished ovarian reserve.
To audit IVF and pregnancy outcomes following ovarian PRP treatment in a cohort of women under 45 years of age with severe diminished ovarian reserve and previous IVF treatment failure.
An audit of 20 consecutive patients comparing embryology outcomes before and after ovarian PRP treatment, together with assessment of PRP-related pregnancies and treatment complications.
Overall, PRP treatment produced no significant improvement in oocyte number, but did increase the number of embryos generated compared to patients' own pre-PRP IVF cycle (zero vs two embryos, P = 0.005). In total four patients conceived viable genetically normal pregnancies in their next IVF cycle, and a further two conceived naturally within 4 months of the PRP treatment. Five of these pregnancies were in women 40 years or older, all being euploid on non-invasive pregnancy screening and viable beyond 12 weeks gestation. No operative complications were observed.
Ovarian PRP treatment appears to be low risk and may offer some promise in assisting pregnancy (natural and IVF-related), especially in women with reduced oocyte quality due to advanced maternal age. Future randomised controlled trials are urgently required to confirm this benefit.
卵子质量差导致的不孕是最难治疗的领域之一。虽然卵子捐赠是一种有效的治疗方法，但对大多数女性来说，这是最后的治疗手段。卵巢富含血小板的血浆（PRP）治疗是一种相对较新的辅助治疗方法，据报道，它可能改善卵巢储备功能严重减退的妇女的卵子质量和体外受精（IVF）治疗结局。
在年龄小于 45 岁且卵巢储备功能严重减退且之前 IVF 治疗失败的女性中，对卵巢 PRP 治疗后的 IVF 和妊娠结局进行审计。
对 20 例连续患者进行审计，比较卵巢 PRP 治疗前后的胚胎学结果，并评估与 PRP 相关的妊娠和治疗并发症。
总体而言，PRP 治疗并未显著增加卵子数量，但与患者自身的 PRP 前 IVF 周期相比，确实增加了胚胎数量（零 vs 两个胚胎，P=0.005）。总共有 4 名患者在下一个 IVF 周期中成功妊娠并获得了可存活的正常遗传胚胎，另外 2 名患者在 PRP 治疗后 4 个月内自然妊娠。这 5 名妊娠患者年龄均在 40 岁或以上，所有患者的非侵入性妊娠筛查均为正常倍体，妊娠超过 12 周。未观察到手术并发症。
卵巢 PRP 治疗似乎风险较低，并且可能在辅助妊娠（自然和 IVF 相关）方面提供一些希望，尤其是在因高龄而导致卵子质量下降的女性中。迫切需要进行未来的随机对照试验来确认这一益处。
