Vol.:(0123456789) 1 3 Molecular Biology Reports https://doi.org/10.1007/s11033-019-04609-w ORIGINAL ARTICLE A report on three live births in women with poor ovarian response following intra-ovarian injection of platelet-rich plasma (PRP) Marzie Farimani 1  · Safoura Heshmati 2  · Jalal Poorolajal 3,4  · Maryam Bahmanzadeh 1,5 Received: 22 November 2018 / Accepted: 16 January 2019 © Springer Nature B.V. 2019 Abstract The prevalence of poor response to gonadotropin stimulation is approximately 9–24% in women undergoing in vitro fertili- zation. Interestingly, due to containing a variety of growth factors, platelet-rich plasma (PRP) can play an important role in tissue regeneration and healing. Thus, in this research, we aimed to investigate the intra-ovarian injection of PRP in women with poor ovarian response. To this goal, 23 poor responders constituted the study population, from among whom 19 women were enrolled. These patients underwent ovarian stimulation according to the Shanghai protocol. Immediately after the frst follicular puncture, 2 mL of PRP was injected into each ovary. 1 day after the frst puncture and PRP injection, the second stimulation was initiated. Then, oocyte retrieval was followed. About 2–3 months after the frst cycle, the patients underwent another treatment with ovarian stimulation according to the Shanghai protocol and then, follicular puncture was performed. The mean numbers of oocytes before and after PRP injection were 0.64 and 2.1, respectively. Two patients experienced spontaneous conceptions. The third case achieved clinical pregnancy and delivered a healthy baby in June 2018. The results of this study appeared to be the frst report on the efects of intra-ovarian PRP injection on the increase of ovarian responses, even on the spontaneous conceptions of women with poor ovarian response. Keywords Platelet rich plasma · Ovary · Infertility · Poor ovarian response · Pregnancy Introduction The prevalence of poor responses to gonadotropin stimula- tion is approximately 9–24% in women undergoing in vitro fertilisation (IVF) [1] .Management of this group of patients was very difcult and various therapeutic approaches had to be adopted to improve the pregnancy rates [2]. Double ovar- ian stimulations could produce more oocytes/embryos in a single cycle of stimulation in the short term, thus serving as a useful strategy for women with poor ovarian response [3–5]. Folliculogenesis generally consists of two phases, namely, gonadotropin-independent (preantral) and gonadotropin- dependent (antral) stages. Follicle development in the pre- antral stage is controlled by intra-ovarian growth factors through autocrine/paracrine mechanisms [6, 7]. Intra-ovarian growth factors include nerve growth fac- tors, KIT ligands and their receptors, members of the transforming growth factor-β superfamily (TGF-β), such as anti-Müllerian hormone, growth differentiation fac- tor 9 (GDF9), bone morphogenetic protein 6 (BMP6), BMP4, BMP7, and BMP15, and fbroblast growth factors (FGFs). Intra-ovarian growth factors play a potential role in the local regulation and modulation of follicular selec- tion and development [7–9]. Platelets can release several growth factors. In particular, platelet-rich plasma (PRP) is a concentration of autologous human platelets (3–5 times higher than the plasma baseline level) containing a variety of hormones, adhesion molecules, cytokines, chemokines, coagulation factors, integrins, and growth factors, such as platelet-derived growth factors (PDGFAA, PDGF-BB, and * Maryam Bahmanzadeh Bahmanzadeh12@yahoo.com 1 Endometrium and Endometriosis Research Center, Hamadan University of Medical Sciences, Hamadan, Iran 2 Department of Genecology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran 3 Research Center for Health Sciences, Hamadan University of Medical sciences, Hamadan, Iran 4 Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran 5 Department of Anatomical Sciences, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran