Ovarian function was restored among some women in early menopause with subcortical administration of platelet-rich plasma (PRP) with gonadotropin. These findings were published in Menopause: The Journal of The North American Menopause Society.

Women (N=12) aged 40 to 50 years who had amenorrhea for more than 1 year were recruited at the Taiwan United Birth-Promoting Expert Fertility Clinic between 2018 and 2019. During a laparoscopic operation, 0.2 mL of activated PRP with gonadotropins were injected into the ovarian cortex (about 15 injections per ovary).

Participants received weekly vaginal ultrasounds. In cases in which follicle growth reached at least 14 mm, in vitro fertilization (IVF) was carried out.


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Patients had a mean age of 44.4 (±2.8) years and all were of Chinese descent. They had been experiencing infertility for 13 (±7.7) years, 9 had a previous pregnancy, and 5 had a previous live birth. Baseline follicle-stimulating hormone (FSH) was 70.5 (±20.9) IU/L and luteinizing hormone (LH) was 34.8 (±11.9) IU/L.

All but one of the women had spontaneous menopause. The other patient may have had menopause induction following left cystectomy 22 years prior.

During the procedure, the right and left ovarian subcortex received 15.2 (±4.8) and 13.7 (±2.6) injections, respectively. Operations lasted an average of 29.3 (±5.8) minutes, during which time ovarian surface oozing was commonly noted.

Follow-up was interrupted by the COVID-19 pandemic. The time of follow-up was less than 2 months (n=3), 2 months (n=2), 3 months (n=1), 4 months (n=2), 5 months (n=2), and 9 months (n=2).

After the procedure, 11 patients resumed menstruation at 37.1 (±23.5) days. These cycles were irregular, lasting between 21 and 71 (mean, 45.6; standard deviation [SD], 13.7) days. FSH and LH were reduced compared with baseline among 61.5% and 60.7% of patients, respectively.

Antral follicles were detected among 10 women with an average of 3.5 (±2.9) follicles. The first follicle detection occurred at 37.2 (±26.5) days and first ovulation at 52.9 (±38.5) days.

Six women underwent IVF, which began with oocyte retrieval at 65.2 (±39.1) days. A total of 10 normally fertilized oocytes were obtained. Cleavage stage embryos were transferred to 2 women. One woman achieved clinical pregnancy but miscarried at week 7.

This study was limited by the disruption caused by the SARS-CoV-2 pandemic, reducing the sample size and follow-up duration of most patients.

These data indicated subcortical injection of activated PRP with gonadotropins had the potential to restore ovarian function among some women in early menopause.

Reference

Hsu CC, Hsu I, Hsu L, Chiu YJ, Dorjee S. Resumed ovarian function and pregnancy in early menopausal women by whole dimension subcortical ovarian administration of platelet-rich plasma and gonadotropins. Menopause. Published online March 29, 2021. doi:10.1097/GME.0000000000001746