Ovarian tissue transplantation using autologous platelet-rich plasma: a pilot clinical trial

Objective: To study the feasibility and safety of using autologous platelet-rich plasma (PRP) during laparoscopic orthotopic reimplantation of cryopreserved ovarian tissue. Design: Single-center, interventional, pilot, prospective, cohort study. Setting: Tertiary university hospital (IRCCS-Azienda Ospedaliero-Universitaria di Bologna-Policlinico Sant'Orsola). Participants: Five eligible consecutive patients, who previously cryopreserved ovarian tissue before chemo(radio) therapy for oncologic diseases and were scheduled for orthotopic reimplantation with the use of autologous PRP to treat iatrogenic premature ovarian failure, were compared with a historical cohort of 19 similar patients who underwent orthotopic reimplantation without the use of autologous PRP. Interventions: Before surgery, autologous PRP (10 mL) was transformed into gel using calcium gluconate. Autotransplantation was performed by standard four-port laparoscopy, creating pockets in the ovarian cortex and/or peritoneal cavity to insert frozen-thawed ovarian tissue fragments covered by gelled PRP. Pre-, intra- and postoperative data were collected (characteristics of the study population, adverse reactions, operative time, surgical complications, menstrual resumption). Results: Study outcomes included: rate of adverse reactions, rate of intra- and postoperative surgical complication, total intraoperative time, rate of restored endocrine function and median (absolute range) time to first menses (expressed in months) during follow-up. The mean (range) age at ovarian tissue retrieval and at transplantation were 30 (27-31) and 38 (36-41) years for the PRP group, and 33 (24-34) and 41 (34-42) years for the non-PRP group. During the study period, no intra- and postoperative complication nor adverse reaction to PRP use was observed. All patients treated with PRP experienced resumption of regular ovarian function after a median (range) period of 3 (1-6) months, with a significant shorter time in the PRP group. One patient in the experimental group conceived three months after surgery and had one live birth at the time of this report. Conclusion: Autologous PRP appears to be a feasible and safe adjunct in orthotopic ovarian tissue transplantation, potentially enhancing the restoration of ovarian function.