Regenerative Effect of Intraovarian Injection of Activated Autologous Platelet Rich Plasma: Serum Anti-Mullerian Hormone Levels Measured Among Poor-Prognosis In Vitro Fertilization Patients
Regenerative Effect of Intraovarian Injection of Activated Autologous Platelet Rich Plasma: Serum Anti-Mullerian Hormone Levels Measured Among Poor-Prognosis In Vitro Fertilization Patients
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卵巢内注射活化的自体富血小板血浆的再生效果：在体外受精患者中测量的血清抗苗勒管激素水平
DOI：
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发表时间：
2020
期刊：
影响因子：
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通讯作者：
Xiang Li
中科院分区：
文献类型：
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作者：
E. Scott Sills;J. Petersen;Natalie S. Rickers;S. H. Wood;Xiang Li
这项注册的前瞻性临床试验评估了用活化富血小板血浆（PRP）治疗后的血清抗苗勒管激素（AMH）模式。卵巢储备功能低下和/或至少有1个体外受精（IVF）周期失败的患者（n=182）在超声引导下接受PRP注射到卵巢组织中。记录治疗前AMH、BMI和血小板（PLT）浓度，然后每隔2周测量一次血清AMH、促卵泡激素和雌二醇，持续3个月。平均±SD患者年龄为45.4± 6.1岁。在51例患者（28%）中观察到血清AMH改善，治疗后中位数增加167% [95%CI 91; 280]; AMH最大增加的平均间隔为4周（范围2-10周）。治疗后AMH的改善并不局限于年轻患者;当按年龄分层时（<42岁vs？42岁），治疗后两组AMH均显著改善（分别为p=0.03和0.009）。在应答者中，平均基础PLT计数（274 K）高于无应答者（250 K）; p<0.001。这是第一个描述卵巢内PRP技术用于低储备的临床试验，并发现治疗安全，并且与某些患者血清AMH的显著增加相关，通常在四周内。PRP应答组之间测量的治疗前PLT浓度存在显著差异，需要进一步研究。进一步的研究可以更好地表征卵巢反应，优化PRP方案，并收集随后用自体卵母细胞进行IVF的患者的结局数据。
This registered, prospective clinical trial assessed serum anti-Mullerian hormone (AMH) patterns after treatment with activated platelet rich plasma (PRP). Patients with low ovarian reserve and/or at least 1 prior failed in vitro fertilization (IVF) cycle (n=182) received PRP injected into ovarian tissue under ultrasound guidance. Pretreatment AMH, BMI and platelet (PLT) concentration were recorded and serum AMH, follicle stimulating hormone, and estradiol were then measured at 2-week intervals for up to three months. Mean±SD patient age was 45.4±6.1yrs. Improved serum AMH was observed in 51 patients (28%) with median increase of 167% [95%CI 91; 280] after treatment; mean interval to maximum AMH increase was 4 weeks (range 2-10 weeks). Improved post-treatment AMH was not limited to younger patients; when stratified by age (<42 vs. ?42yrs), significant AMH improvements were seen in both groups after treatment (p=0.03 and 0.009, respectively). Among responders, mean basal PLT count was higher (274K) vs. non-responders (250K); p<0.001. This is the first clinical trial to describe an intraovarian PRP technique for low reserve and finds the treatment safe and associated with significant increases in serum AMH for some patients, usually within four weeks. The substantially different pre-treatment PLT concentrations measured across PRP response groups warrants further investigation. Additional research can characterize ovarian response better, optimize PRP protocols, and collect outcomes data from those who subsequently undergo IVF with autologous oocytes.