Exploring the potential of PRP therapy to activate folliculogenesis in women of late reproductive age
Explore the ScienceImagine a biological clock not with hands that turn, but with follicles that dwindle. For a growing number of women in their late reproductive years (typically defined as 35 and older), this is not a metaphor but a medical reality.
As age advances, the ovarian reserve—the number and quality of remaining eggs—diminishes, turning the dream of conception into a formidable challenge. In the world of Assisted Reproductive Technologies (ART), these women often face a diagnosis of Poor Ovarian Response (POR), a condition where the ovaries produce few eggs in response to fertility drugs, leading to lower success rates for in vitro fertilization (IVF) 1 .
For decades, the options have been limited. However, a novel and promising treatment has emerged from an unexpected source: the patient's own blood. Platelet-Rich Plasma (PRP) therapy, a regenerative technique celebrated in orthopedics and dermatology, is now making waves in reproductive medicine.
This article explores the science behind this innovative approach, investigating how an injection of concentrated platelets might help "reawaken" the ovaries and offer new hope to those struggling with age-related fertility decline.
Platelet-Rich Plasma is exactly what its name suggests: a portion of a patient's own blood that has been processed to concentrate the platelets. Platelets are tiny, disc-shaped cell fragments best known for their role in clotting. However, they are also powerhouses of healing, packed with granules filled with bioactive growth factors and cytokines 9 .
To create PRP, a small sample of a patient's blood (typically 20-60 mL) is drawn. This blood is then placed in a centrifuge and spun at specific speeds. This process separates the blood into its components: red blood cells sink to the bottom, while the platelet-rich plasma forms a layer that can be extracted 6 8 . The result is a liquid with a platelet concentration 4 to 5 times higher than that of normal blood, supercharged with healing potential .
The fundamental question is: how could a plasma injection influence something as complex as egg development? The answer lies in the potent cocktail of growth factors that platelets release upon activation.
Once injected into the ovarian stroma (the functional tissue), the concentrated platelets degranulate, releasing a symphony of signaling molecules. Key players include 4 9 :
Recent research has pinpointed a specific cellular pathway through which PRP appears to work: the PI3K/Akt signaling pathway 2 . This pathway is a crucial regulator of cellular growth, survival, and metabolism. In the ovary, it helps control the activation of primordial follicles—the vast, dormant reservoir of immature eggs every woman is born with.
For a primordial follicle to begin its long journey of growth and development into a mature egg capable of ovulation, this pathway must be "switched on." Studies on both mouse and human ovarian tissue have demonstrated that PRP actively promotes this activation process, effectively encouraging these dormant follicles to re-enter the growth cycle 2 4 .
Reduces apoptosis in ovarian cells
Exerts anti-inflammatory effects
Stimulates granulosa cell proliferation
The theory is compelling, but what does the data from clinical studies actually show? Recent research offers promising, though still preliminary, evidence.
A 2025 retrospective study published in Scientific Reports provides a clear example. This study involved 74 IVF patients with a history of poor embryo quality. Forty-four of them received an intraovarian PRP injection between two controlled ovarian hyperstimulation (COH) cycles. The results were striking .
| Outcome Measure | Control Group (No PRP) | PRP Group | P-value |
|---|---|---|---|
| Number of Fertilized Oocytes | 3.3 ± 3.5 | 5.2 ± 3.6 | 0.011 |
| Total Blastocysts | 0.5 ± 0.7 | 1.7 ± 1.5 | <0.0001 |
| Good Quality Blastocysts | 0 ± 0.2 | 0.6 ± 0.8 | <0.0001 |
| Total Blastocyst Rate | 13 ± 24% | 35 ± 31% | 0.001 |
| Good Quality Blastocyst Rate | 1 ± 3% | 14 ± 22% | <0.0001 |
Data adapted from
Another 2025 study focused specifically on women with Poor Ovarian Response (POR), as defined by the Bologna criteria. After propensity score matching, the researchers compared 91 cycles with PRP to 261 control cycles 1 .
| Outcome Measure | Control Group | PRP Group | P-value |
|---|---|---|---|
| Follicles ≥ 14 mm on Trigger Day | 2.26 ± 1.44 | 2.96 ± 1.79 | <0.001 |
| Number of Retrieved Oocytes | 2.07 ± 1.78 | 2.86 ± 1.88 | <0.001 |
| Normally Fertilized Zygotes (2PN) | 1.37 ± 1.44 | 1.73 ± 1.42 | 0.044 |
Data adapted from 1
Perhaps one of the most remarkable findings comes from a larger pre-post study in Turkey. Following intraovarian PRP injection in 234 women with POR, not only did IVF outcomes improve, but 9% of the women (21 individuals) achieved spontaneous pregnancy without any further ART intervention after the treatment 8 .
| Outcome | Number of Women | Percentage |
|---|---|---|
| Spontaneous Pregnancy | 21 | 9.0% |
| Underwent IVF after PRP | 192 | 82.0% |
| Embryo Transferred | 106 | (of 188 with embryos) |
| Ongoing Pregnancy/Live Birth | 39 | 36.8% per transfer |
Data adapted from 8
Hypothetical data visualization showing improvements in IVF outcomes following PRP treatment
The preparation of PRP is a precise process that relies on specific reagents and materials to ensure the final product is both safe and effective.
| Reagent/Material | Function | Key Considerations |
|---|---|---|
| Anticoagulant Vials | Prevents blood from clotting before PRP is separated | ACD-A (Acid Citrate Dextrose-A) is considered superior as it best preserves platelet function and morphology, leading to a higher yield of viable platelets 5 |
| Centrifuge | Separates blood components by density through spinning | Specific protocols (time, speed, "double-spin" vs. "single-spin") vary, impacting the final platelet concentration and white blood cell content 3 9 |
| Calcium Chloride | Used to activate the platelets after concentration, triggering the release of growth factors | Activation is a critical final step before injection; without it, growth factor release may be suboptimal 5 |
| PRP Commercial Kits | Standardized kits (e.g., T-Lab kit) that provide all necessary components for a closed, sterile procedure | Helps reduce variability in preparation, though differences between kits can still lead to inconsistent PRP compositions 6 8 |
| Transvaginal Ultrasound Probe with Needle Guide | Allows for precise, real-time guidance of the injection needle into the ovarian stroma | Ensures the PRP is delivered accurately and safely to the target site, minimizing risk to surrounding tissues 1 8 |
For a patient undergoing this therapy, the process is typically completed in a single session and involves several key steps:
The concentrated PRP is drawn into a syringe. In some protocols, calcium chloride is added at this stage to activate the platelets, priming them to release their growth factors upon injection 5 .
Under sedation or local anesthesia, a doctor uses a transvaginal ultrasound probe to guide a long, thin needle through the vaginal wall and into each ovary. Approximately 2-4 mL of the activated PRP is injected into multiple sites within the ovarian stroma to maximize distribution 1 8 .
The procedure is usually done on an outpatient basis, and patients can go home the same day. The timeline for seeing effects is not instantaneous; it takes time for the biological processes to unfold. Studies suggest that the optimal window for performing an IVF cycle after PRP injection is one to two months later .
Platelet-Rich Plasma therapy represents a fascinating convergence of regenerative medicine and reproductive science. By harnessing the body's innate healing mechanisms, it offers a novel strategy to address the deeply personal and complex challenge of age-related infertility. The growing body of evidence, showing increases in follicle counts, retrieved oocytes, and—most importantly—viable blastocysts and pregnancies, is undoubtedly encouraging 1 .
However, it is crucial to view this innovation with balanced optimism. The European Society for Human Reproduction and Embryology (ESHRE) and many clinicians still classify ovarian PRP as experimental 3 7 . Significant challenges remain, including a lack of standardized protocols for preparation and dosage, and a need for larger, randomized controlled trials to firmly establish its efficacy and long-term safety.
Despite these caveats, PRP therapy ignites a beacon of hope. It symbolizes a shift in perspective—from merely working with a dwindling ovarian reserve to actively exploring ways to rejuvenate it. For women in their late reproductive age navigating the difficult path of ART, this "silent clock" may not be so immutable after all, and the ticking may just be getting started.