Combined Use of PRP and Exosomes in Poor Responders Aged 35-43: A Retrospective Controlled Group Study

Background: Poor ovarian response (POR) remains a substantial challenge in assisted reproductive technologies (ART), especially in women older than 35 years. Regenerative therapies such as platelet-rich plasma (PRP) and exosomes have emerged as promising interventions. Objective: To evaluate the clinical impact of intraovarian injections of PRP enriched with mesenchymal stem cell (MSC) – derived exosomes on in vitro fertilization (IVF) outcomes in poor responders. Materials and Methods: A retrospective controlled study was conducted with 126 women aged 35-43 years undergoing IVF. Patients were divided into two subgroups: 35-40 years and 40-43 years. The intervention group received intraovarian PRP plus exosome treatment; the control group received standard stimulation only. Primary outcomes included metaphase II (MII) oocyte count, fertilization rate, blastocyst development, and clinical pregnancy rate. Results: The PRP plus exosome group showed a 35% increase in MII oocytes, 20%-30% higher fertilization, and 15%-20% improved blastocyst development. Clinical pregnancy rates rose by 15%-17%, with better outcomes in the younger subgroup. Conclusions: Regenerative therapy using PRP and MSC-derived exosomes may improve ovarian response and IVF outcomes in poor responders.