Der Einsatz von „platelet-rich plasma“ (PRP) bei reduzierter ovarieller Reserve und ovarieller Insuffizienz – Hoffnung oder ungerechtfertigter Hype?

Premature ovarian insufficiency (POI) and diminished ovarian reserve (DOR) are probably the main challenges in reproductive medicine, not least in view of the increasing trend in postponing family planning. Both the clinical picture of POI and age-related and physiological DOR are irreversible in principle. Despite the use of state-of-the-art reproductive medicine techniques, the chances of realizing the desire to have children in the case of age-related DOR or manifest POI—apart from egg donation—are considered to be low. Platelet-rich plasma (PRP), a blood plasma product with increased platelet concentrations, is used in many areas of medicine. Its use is postulated to have pro-angiogenic, proliferative and immunomodulating effects. Some publications also suggest that intraovarian PRP application could have a positive effect on the ovary. This intraovarian PRP application is now also being advertised, sometimes quite sensationally, as “ovarian rejuvenation therapy” or “ovarian regeneration”. Depending on the study, intraovarian PRP injections are suggested to improve ovarian reserve, increase the number of eggs and embryos yielded—occasionally also improve the rate of euploid eggs—and to increase the chances of pregnancy. How should intraovarian PRP application, which is enjoying increasing demand, be evaluated? This paper is intended to provide an overview of the evidence and to examine the underlying working hypotheses of PRP in detail. The physiological processes of ovarian ageing and the clinical picture of POI will also be discussed.