Does Ovarian Platelet-Rich Plasma (PRP) Require a Surgical Approach? A Retrospective Comparison Between Laparoscopic and Transvaginal Administration

Intraovarian platelet-rich plasma (PRP) has been proposed as an experimental treatment for women with diminished ovarian reserve and poor ovarian response, but the optimal route of administration remains unclear. This study compared laparoscopic and transvaginal ultrasound-guided PRP administration and investigated whether the route of injection was independently associated with ovarian response and reproductive outcomes. This retrospective multicenter study included 119 women undergoing intraovarian PRP at two Italian fertility centers: 50 received laparoscopic PRP and 69 underwent transvaginal ultrasound-guided administration. In both groups, 3 mL of PRP was injected into each ovary. Post-treatment ovarian response was available for 79 women. Primary outcomes were the numbers of retrieved and mature (MII) oocytes. Secondary outcomes included embryo yield, pregnancy outcomes, and longitudinal changes in ovarian reserve markers. Multivariable linear regression was used to adjust for baseline anti-Müllerian hormone (AMH), antral follicle count (AFC), and double ovarian stimulation (DUO-STIM). Retrieved oocytes were 4.64 ± 3.61 after laparoscopic versus 3.45 ± 3.86 after transvaginal administration (p = 0.06), while MII oocytes were 3.38 ± 2.84 versus 2.83 ± 3.04 (p = 0.25). After adjustment for AMH, AFC, and DUO-STIM, the route of administration was not independently associated with retrieved (β −0.78; 95% CI −2.49 to 0.92; p = 0.37) or mature oocytes (β −0.23; 95% CI −1.56 to 1.11; p = 0.74). DUO-STIM was positively associated with both outcomes. In the transvaginal cohort, a modest early increase in AMH was not sustained over subsequent follow-up. Pregnancy analyses were exploratory because of the limited number of embryo transfers. The route of intraovarian PRP administration was not independently associated with ovarian response after accounting for baseline ovarian reserve and stimulation strategy. These findings do not demonstrate an advantage of laparoscopic administration and support further prospective evaluation of the less invasive transvaginal approach using standardized PRP and stimulation protocols.