New Approach For Ovarian PRP Injection for poor responders ; Aiming at the Highest Response rate

Background: reports indicated significant enhancement of ovarian reserve parameters post-PRP injection; however, no uniform agreement was reached on the injection route, the delivered volume, or the location of PRP placement in the ovary. Methods: This is a prospective clinical observational study in which we included 35 women with a history of unsuccessful ICSI trial due to poor ovarian response. PRP was injected in each ovary in 2 cycles. In the first cycle, injection was done via Laparoscopy and in the second cycle was injected transvaginally. 3ml of concentrated PRP was injected via 3 injections, 2 subcortical and 1 intramedullary. After, almost 12 weeks of the first injection, embryo transfers were carried out following our routine ICSI program. Results: The results showed a marked improvement of all ovarian reserve parameters after 2 cycles of PRP injection. The mean value of FSH before injection was 13.6 mIU, while after it was 7.94 mIU. The mean value of AMH was 0.34 ng/ml before, compared to 0.67 ng/ml after. The mean AFC was 1.9 before and 4.6 after. The mean number of oocytes was 1.74 before and 2.42 after. The mean number of embryos was 0.62 before and 1.71 after PRP. The pregnancy rate in this study was 37%. Conclusion: This study revealed that injection PRP in each ovary using 3 injections, is safe and effective to improve all ovarian reserve parameters, oocytes number and quality together with embryo quality. Patients with AFC Zero, may not be encouraged to undergo this type of management.