Comparative efficacy of single vs. double autologous platelet-rich plasma ovarian injections for improving ovarian response in poor ovarian responders

Poor ovarian response (POR) is a challenge in reproductive medicine, often leading to suboptimal outcomes in IVF/ICSI cycles. Autologous platelet-rich plasma (PRP) injections have emerged as a potential therapy to enhance ovarian function. This study aims to compare the efficacy of single versus double PRP ovarian injections in improving ovarian reserve, response to stimulation, and IVF/ICSI outcomes in women with POR. This before-and-after study was conducted at the Reproductive Center of the Sixth Affiliated Hospital of Sun Yat-sen University. Seventy-one women diagnosed with POR (POSEIDON group 3 or 4), characterized by anti-Müllerian hormone (AMH) levels below 1.2 ng/mL and fewer than five antral follicles, who had completed at least one IVF/ICSI cycle before and after PRP treatment were included. Participants received intraovarian injections of autologous PRP (2-2.5 mL per ovary) via transvaginal ultrasound guidance, either once or twice as determined clinically. We evaluated changes in ovarian reserve markers (AMH and antral follicle count [AFC]) and IVF/ICSI outcomes, such as the number of retrieved oocytes and quality embryos. Comparative analysis between single and double injections utilized the difference (Δ) between post- and pre-treatment values. PRP treatment resulted in significant improvements in AMH levels (from 0.33 ± 0.24 ng/mL to 0.43 ± 0.29 ng/mL, p = 0.005) and AFC (from 2.62 ± 1.09 to 3.80 ± 1.95, p < 0.001). Both single and double PRP injections significantly increased the number of retrieved oocytes (2.32 ± 1.80 vs. 3.59 ± 2.00, p < 0.001) and high-quality embryos (0.73 ± 1.08 vs. 1.28 ± 1.21, p = 0.002). Subgroup analysis indicated no significant differences in ΔAMH, ΔAFC, or IVF/ICSI outcomes between single and double treatments. However, the increase in AMH levels reached statistical significance only after double PRP injection, not after single injection. Autologous PRP ovarian injections significantly improve ovarian reserve parameters, the number of oocytes retrieved and high-quality embryos in women with POR. A single PRP injection is as effective as double injections, suggesting a more cost-effective and simpler protocol for clinical application.