Platelet-rich plasma may restore ovarian function in early menopause
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An injection of platelet-rich plasma and gonadotropins near the ovarian follicles may help restore ovarian function for early menopausal women, according to data from a pilot study published in Menopause.
In a cohort of 12 early menopausal women, 11 resumed their menstrual cycle a little more than 1 month after receiving an injection of platelet-rich plasma and recombinant follicle-stimulating hormone in the extended subcortical area of the bilateral ovaries.
“The retained immature follicles in ovaries of early menopausal women can be enhanced or stimulated to grow to mature follicles employing our new method, the whole dimension subcortical administration of platelet-rich plasma and gonadotropins,” Chao Chin Hsu, MD, PhD, of Taiwan United Birth-Promoting Experts (TUBE) Fertility Clinic in Tainan, Taiwan, told Healio. “We have proven successful oocyte retrieval to obtain mature oocytes for in vitro fertilization and embryo transfer in six early menopausal women, and one reached clinical pregnancy.”
Hsu and colleagues enrolled 12 ethnic Han Chinese women aged 40 to 50 years who had amenorrhea for more than 1 year and were referred to the TUBE Fertility Clinic between November 2018 and November 2019 (mean age, 44.4 years). All participants underwent routine preoperative evaluation before the procedure. The platelet-rich plasma was prepared from 40 mL of peripheral blood by the buffy coat protocol. A laparoscopic operation was performed in which 5 mL of platelet-rich plasma was combined with 300 IU of recombinant follicle-stimulating hormone. Injections of 0.2 mL were performed at each point of the superficial layer of the ovarian cortex and 15 injection sites in each ovary.
After treatment, participants were asked to have regular follow-up for 6 months or longer, including vaginal ultrasound scanning at weekly intervals to detect ovarian follicle growth. Participants who resumed ovarian function had in vitro fertilization carried out through the natural ovulatory cycle or under conventional controlled ovarian stimulation.
Menstrual cycle resumed in nearly all participants
All 12 participants completed the procedure without specific complaints other than a mild pain over the lower abdomen. Due to the COVID-19 pandemic, most participants were restricted from attending scheduled visits and follow-up, and the cohort had a mean follow-up time of 125 days.
Of the 12 participants, 11 resumed their menstrual cycle during a mean period of 37.1 days. Seven women resumed their period within 1 month, three resumed their period in about 2 months, and one participant took nearly 3 months. The resumed menstrual cycles were mostly irregular, with a mean duration of 45.6 days.
Of those who resumed their menstrual cycle, the average follicle-stimulating hormone level dropped from 70.5 IU/L at baseline to 26.2 IU/L on day 2 to 3 after resumption. Luteinizing hormone levels also dropped from 34.8 IU/L before treatment to 14.3 IU/L after menstrual cycle resumption.
Pregnancy possible after treatment
There were 10 oocyte retrieval procedures performed on six participants, with a mean interval of 65.2 days between treatment and first oocyte retrieval. Thirteen mature eggs were retrieved and fertilized through intracytoplasmic sperm injection to obtain 10 normally fertilized two pronuclei oocytes. Two participants had cleavage stage embryos transferred, and one achieved clinical pregnancy.
“This administration mode provides another treatment scenario for women of early menopause and those of impending ovarian failure to have better opportunity to conceive using their own eggs,” Hsu said. “There are also several devastating menopausal symptoms in women of early menopause, such as hot flashes, sweating and genitourinary syndrome, due to the dramatic decrease of ovarian hormones. Our study showed the regain of follicle growth with elevated serum estradiol level in most menopause women receiving our treatment. Thus, this application might help to relieve the symptoms and signs of early menopause.”
Hsu said further research should be done with a larger and more diverse study population, including women in a more advanced stage of menopause, and those with cancer receiving chemotherapy or radiotherapy.
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