Merhi Zaher, Seckin Serin, Mouanness Marco
Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, SUNY Downstate Health Sciences University, New York, NY, USA.
Rejuvenating Fertility Center, New York, NY, USA.
Clin Exp Reprod Med. 2022 Sep;49(3):210-214. doi: 10.5653/cerm.2021.05057. Epub 2022 Aug 31.
Platelet-rich plasma (PRP) therapy has received a considerable attention as an adjunct to fertility treatments, especially in women with very low ovarian reserve and premature ovarian insufficiency. Although recent studies have demonstrated that PRP led to improvements in folliculogenesis and biomarkers of ovarian reserve, the effect of intraovarian PRP administration on embryo genetics has not been studied.
We report a pilot study of patients who had preimplantation genetic testing for aneuploidy (PGT-A) before and then within 3 months following PRP administration. Twelve infertile women with at least one prior failed in vitro fertilization (IVF) cycle underwent ovarian stimulation (cycle 1) with a gentle stimulation protocol and PGT-A performed at the blastocyst stage. Following cycle 1, autologous intraovarian PRP administration was performed. Within 3 months following PRP administration, the patients underwent cycle 2 and produced blastocysts for PGT-A. The percentage of euploid embryos between both cycles was compared.
The mean age of all participants was 40.08±1.46 years, and their mean body mass index was 26.18±1.18 kg/m2. The number of good-quality embryos formed at the blastocyst stage was similar between cycle 1 and cycle 2 (3.08±0.88 vs. 2.17±0.49, respectively; p=0.11). Among all patients in cycle 1, 3 of 37 embryos were euploid (8.11%) while in cycle 2, 11 out of 28 embryos were euploid (39.28%, p=0.002). Three clinical pregnancies were noted among this patient group.
This novel study is the first to present an improvement in the embryo euploidy rate following intraovarian PRP application in infertile women with prior failed IVF cycles. The growth factors present in PRP may exhibit a local paracrine effect that could improve meiotic aberrations in human oocytes and thus improve euploidy rates. Whether PRP improves live birth rates and lowers miscarriage rates remains to be determined in large trials.
富血小板血浆（PRP）疗法作为辅助生育治疗手段受到了广泛关注，尤其是对于卵巢储备极低和卵巢早衰的女性。尽管最近的研究表明PRP可改善卵泡生成和卵巢储备生物标志物，但卵巢内注射PRP对胚胎遗传学的影响尚未得到研究。
我们报告了一项对患者的初步研究，这些患者在接受PRP治疗前和治疗后3个月内进行了非整倍体植入前基因检测（PGT-A）。12名至少有一次体外受精（IVF）周期失败的不孕女性接受了温和刺激方案的卵巢刺激（第1周期），并在囊胚阶段进行了PGT-A检测。在第1周期后，进行了自体卵巢内PRP注射。在PRP注射后3个月内，患者接受第2周期治疗并产生囊胚用于PGT-A检测。比较两个周期之间整倍体胚胎的百分比。
所有参与者的平均年龄为40.08±1.46岁，平均体重指数为26.18±1.18kg/m²。第1周期和第2周期在囊胚阶段形成的优质胚胎数量相似（分别为3.08±0.88和2.17±0.49；p=0.11）。在第1周期的所有患者中，37个胚胎中有3个是整倍体（8.11%），而在第2周期中，28个胚胎中有11个是整倍体（39.28%，p=0.002）。该患者组中有3例临床妊娠。
这项新研究首次表明，在先前IVF周期失败的不孕女性中，卵巢内应用PRP后胚胎整倍体率有所提高。PRP中存在的生长因子可能表现出局部旁分泌作用，可改善人类卵母细胞的减数分裂异常，从而提高整倍体率。PRP是否能提高活产率和降低流产率仍有待大型试验确定。
