Efficacy of Autologous Platelet-Rich Plasma in Ovarian Stimulation and In Vitro Fertilization: Impact of Obesity on Reproductive Outcomes

Efficacy of Autologous Platelet-Rich Plasma in Ovarian Stimulation and In Vitro Fertilization: Impact of Obesity on Reproductive Outcomes | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Efficacy of Autologous Platelet-Rich Plasma in Ovarian Stimulation and In Vitro Fertilization: Impact of Obesity on Reproductive Outcomes Dinorah Hernández-Melchor, Juan José Suárez, Leonardo M. Porchia, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7586051/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose To evaluate the effectiveness of intraovarian autologous platelet-rich plasma (PRP) on controlled ovarian stimulation (COS) and in vitro fertilization (IVF) outcomes, and to assess the potential modifying role of obesity on treatment response. Methods This retrospective self-controlled study included 299 women (25–49 years) with a history of at least one failed IVF cycle who received intraovarian PRP between September 2021 and January 2024. Patients underwent COS and IVF post-treatment. Outcomes included hormonal response, cycle cancellation rate, number of retrieved oocytes, embryo development, and pregnancy rates. Using BMI, patients were stratified into normal weight (18.5–24.9 kg/m²), overweight (25.0-29.9 kg/m²), and obese (≥ 30.0 kg/m²). Results Following PRP treatment, the COS cycle cancellation rate significantly decreased from 32.6% to 11.1% (p < 0.001). Improvements were seen across all BMI categories. The number of transferable embryos increased (p = 0.035), and implantation rates rose from 2.0% to 14.0% (p < 0.001). A significant increase in ongoing pregnancy/live birth rates was observed (0.0% vs. 10.4%, p < 0.001). Obese patients showed improvement but had less favorable implantation outcomes. PRP was generally safe, though mild to moderate bleeding occurred in a subset of patients. Conclusion Intraovarian PRP appears to enhance COS and IVF outcomes, particularly by improving embryo development and implantation. However, obesity may attenuate these effects. Further randomized controlled trials are needed to confirm efficacy and optimize patient selection and treatment timing. Assisted reproductive technology obesity ovarian regeneration PRP poor ovarian response Figures Figure 1 What does this study adds to the clinical work This study shows that intraovarian autologous platelet-rich plasma can reduce in vitro fertilization cycle cancellations and improve embryo implantation and live birth rates, even in women with poor ovarian reserve. However, obesity attenuates these benefits, highlighting the importance of considering metabolic status when selecting candidates for platelet-rich plasma therapy. Introduction Currently, in vitro fertilization (IVF) assists infertile women in increasing the possibility of achieving pregnancy. However, the biological disability of the ovaries and endometrium remains a barrier for reproductive medicine. Both organs represent significant challenges, as they are hormonally regulated tissues and undergo proliferative and secretory changes during each menstrual cycle. The lack of ova represents a limitation that has not been resolved [ 1 ]. Ovaries contain a limited group of primordial follicles with reproductive and endocrine functions. In women with low ovarian response, primary ovarian insufficiency, or menopause, residual dormant follicles still reside that could potentially be rescued to increase the final oocyte yield [ 1 ]. Therapeutic strategies to address the lack of growth and development in the ovary include drugs and surgical interventions that do not solve the problem and become the limiting factor that prevents success in assisted reproduction processes. In recent years, using cellular products or their derivatives has become a promising alternative for treating ovarian problems [ 2 ]. Studies have demonstrated the potential for regenerating the damaged ovarian niche through platelet-rich plasma (PRP) therapies in women with impaired ovarian reserve, resulting in significant improvements in the hormonal profiles of these patients, resumption of menstruation, and even spontaneous pregnancies or pregnancies through assisted reproductive techniques [ 1 ]. PRP is an autologous protein concentrate prepared from the patient's peripheral blood that contains a large number of growth factors and cytokines, such as vascular endothelial growth factor (VEGF), beta growth transformer (TGF-β), platelet-derived growth factor (PDGF) and epidermal growth factor (EFG), which facilitate tissue repair and regeneration as they can stimulate proliferation and angiogenesis in the tissue where they are applied [ 3 ]. However, these growth factors and cytokines are affected by obesity [ 4 , 5 ], which was shown to alter the PRP isolate [ 6 , 7 ]. Nevertheless, the results of these different studies seem to indicate that regenerative medicine is an adequate and efficient complement to the treatment of female infertility, and, therefore, further exploration and research should be carried out to find an effective and safe treatment for this condition that affects so many couples around the world. Therefore, this study aimed to determine the effectiveness of intraovarian autologous platelet-rich plasma (PRP) in controlled ovarian stimulation and in vitro fertilization (IVF), as well as the impact of obesity on treatment outcomes. Materials and Methods Study design and participants A chart review for a single-arm, retrospective, self-controlled study was conducted from September 2021 to January 2024, following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines [ 8 ]. The cohort pool consisted of patients who were attending any clinic of the Ingenes Institute. They had to fulfill the following inclusion criteria: 1) received unilateral or bilateral intraovarian PRP injection and continued with COS after the procedure, 2) age between 25 and 49 years at the time of PRP application and had a history of at least one failed IVF cycle, and 3) had at least one normal ovary with a dominant diameter not less than 20 mm at the time of PRP application. The patients were excluded if it was documented or suspected that 1) the patient suffered from an auto-immune disease, thrombophilia, hematologic disorders, uncontrolled endocrine or other medical conditions, congenital and untreated acquired ovarian or uterine lesions, or 2) coupled with genetic and chromosomal abnormalities. Autologous PRP Preparation and Intraovarian Injection For PRP preparation, 18 mL of venous blood was drawn from patients using six 3-mL sample collection tubes containing 3.8% sodium citrate. First, the blood samples were centrifuged at 15000 rpm for 20 minutes. Then, the serum phase was discarded, and 0.3–0.5 mL of PRP was collected from each tube, resulting in a final PRP volume of 2 mL. PRP was injected into the ovaries within the next 10 minutes. PRP injection was performed under transvaginal ultrasound guidance and sedation anesthesia during the late follicular phase of the menstrual cycle bilaterally or into at least one ovary. The procedure was performed under intravenous sedation with an antibiotic (cefazolin 1 g IV) and antihemorrhagic (etamsylate 500 mg IV) coverage. Under transvaginal ultrasound guidance with a guidewire, autologous PRP (1.5-2 ml) was injected into each ovary with a 35 cm 17 G single-lumen Cook needle. The ovaries were aligned with the needle guide to avoid intervening vascular or other structures; the needle was quickly inserted without rotation deep into the central ovary. Once tip placement was confirmed, PRP was slowly injected into the cortex-medulla's mesovarium clockwise at 10 and 3 o'clock. Compressive hemostasis was performed for five minutes, and ultrasound guidance (USG) was used to verify the absence of bleeding. If hemoperitoneum was observed, culdocentesis was performed to remove any free fluid in the pelvic cavity. After a second examination of the cavity, patients were taken to the recovery room and, 60 to 90 minutes later, discharged. The severity of complications was assessed and recorded by the physician. See Online Resource 1 for diagnosis criteria. For mild bleeding cases, blood was drawn in the operating room before the patient was transferred back to the recovery room. For moderate bleeding cases, the patient was observed for two hours before being discharged. Severe bleeding patients reported abdominal pain and pain radiating to the shoulder (> 5/10 on the VAS scale) in the recovery room. They required a culdocentesis for hemoperitoneum resolution 60–90 minutes after PRP injection. Controlled Ovarian Stimulation and Oocyte Retrieval After an average of 12 weeks, controlled ovarian stimulation was initiated. Patients underwent controlled ovarian stimulation for 10 to 14 days using gonadotropin-releasing hormone agonists and antagonists. Serum estradiol levels and ultrasound evaluation of follicular development were used to monitor the ovarian response. When the leading follicles reached a diameter of > 18 mm, recombinant human chorionic gonadotropin (hCG) was administered as a trigger. Oocyte retrieval was conducted 36 hours later under ultrasound guidance, where all 14–18 mm follicles were aspirated. In Vitro Fertilization At the same time as oocyte retrieval, semen was prepared by density gradient centrifugation. Oocytes were individually decumulated, and the biologist recorded their quality and maturity status. The oocytes were inseminated by intracytoplasmic sperm injection, and fertilization was judged by forming two pronuclei 19 hours after insemination. Embryos were cultured in Global Total for Fertilization media (Cat. # LGGT-30, Life Global) and incubated at 37°C in a 5% O 2 , 8% CO 2 , and 87% N 2 atmosphere. An embryologist monitored and recorded all information about egg number and quality, semen quality, fertilization rates, embryo development, and embryo morphology for each oocyte. Embryo Transfer With the patient’s approval, the physician determined the cycle and the number of embryos to transfer. Patients underwent transfer with frozen-thawed blastocysts during an estrogen-primed cycle, while fresh transfers were preferred for Day 3 embryos. Embryo implantation was confirmed on Day 10 or 14 through serum β-hCG concentrations (> 10 mIU/ml) or by detecting a fetal heartbeat via ultrasound at 6–8 weeks. The physician recorded all relevant patient demographics, IVF cycle information, implantation rates, and IVF outcomes, including pregnancies and miscarriages. Statistical analysis All analyses were performed using the Statistical Package for the Social Sciences software (SPSS, v. 26.0, Chicago, IL, USA). Normality of continuous variables was determined using the Kolmogorov-Smirnov test. Differences between pre- and post-data were determined with either the McNemar test, the paired T-test, or the Wilcoxon Signed Ranks Test. The cohort was stratified into three groups by BMI: normal weight (BMI: 18.5–24.9 kg/m²), overweight (BMI: 25.0-29.9 kg/m²), or obese (BMI: 30.0-39.9 kg/m²). Unless noted otherwise, data are represented as the frequency, percent, or mean ± standard deviation or standard error. P-values < 0.05 (two-tailed) were considered significant. Results Selection of the participants During the study period, 13,319 COS cycles were performed on 9,987 patients from December 2021 to September 2024. Intraovarian PRP was applied to 2.9% of these cycles. From these cases, only 299 fulfilled the inclusion criteria and had COS (Fig. 1). Although most patients improved with COS, 19.7% had a secondary post-treatment, 4.0% had a third, and 1.7% had a fourth (the maximum allowed by the clinic). The patients’ characteristics are presented in Table 1 . It should be noted that one patient, after receiving intraovarian PRP, spontaneously became pregnant. Figure 1 The study flow chart demonstrating the selection of patients Table 1 Characteristics of the population Category Value Sample (n) 298 Patient age (years) 39.2 ± 0.2 (min: 27, max: 49) Partner age (years, n = 254) 40.1 ± 0.4 (min: 24, max: 64) BMI (kg/m 2 ) 24.8 ± 0.2 (min: 17.5, max: 40.9) Normal weight (%) 55.9 Overweight (%) 36.1 Obese (%) 8.0 Infertility (years) 3.6 ± 0.2 (min: <1, max: 40.9) Previous failed IVF cycles 2.0 ± 0.1 (min: 0, max: 10) Patient etiology (%) Unilateral anexectomy 0.3 Anovulation 0.7 Low ovarian reserve 1.0 Low ovarian response 30.1 Advanced maternal age 45.2 Endometriosis 4.0 Gestational failure 1.3 Premature Ovarian Failure 1.3 Low oocyte quality 5.0 Polycystic ovary syndrome 1.7 Tubal ligation 1.3 Not reported‎/unknown 8.0 Partner etiology (%) Normozoospermia 16.7 Asthenoterate 12.4 Azoospermia 2.6 Hydrocele 0.3 Oligoasthenoteratozoospermia 5.4 Teratozoospermia 47.8 Oligoazoospermia 0.3 Not reported‎/ unknown 0.7 Sperm bank 13.7 Values are either mean ± standard error or percentage. Control of surgical complications after intraovarian PRP injection All possible complications were closely monitored. Mild ovarian bleeding (< 15 ml) was the most frequent complication after intraovarian PRP injection, presenting in 159 cases (44.9%). Moderate hemoperitoneum (greater than 50 ml) was reported in 12.5% (n = 43) of cases and was managed within the operating room without further complications. Twelve patients (3.4%) suffered from severe hemoperitoneum (> 500 ml) and required a follow-up with culdocentesis to resolve the condition. Among the severe complications group, nine patients were of normal weight, and one was overweight. A detailed description of the characteristics of the complications is in the Supplementary Table. Intraovarian PRP improved COS. The cycle cancellation rate was assessed using the last post-treatment cycle and compared to the patient’s previous cycle before intraovarian PRP (n = 298). During the previous COS cycle, 32.6% resulted in the cancellation of oocyte retrieval (n = 97); however, treatment with intraovarian PRP led to a significant decrease in COS cancellation (11.1%, n = 33, p < 0.001). When stratified by BMI class, there was a significant decrease in cycle cancellation for normal-weight patients (22.1% versus 10.2%, p < 0.001), overweight patients (39.8% versus 13.9%, p < 0.001), and obese patients (37.5% versus 4.2%, p = 0.005). Even though the rate improved in cycle cancellation (-11.9%, -25.9%, -33.3%, respectively), there was no observed interaction between BMI and treatment. Of the 299 patients, only 182 had data available both before and after intraovarian PRP treatment. When considering E2 measurements, only the first measurement (Days 3–5) showed a significant increase in E2 (p = 0.015, Table 2 ). There was no effect for the 2nd (Days: 6–8) and 3rd (Days: 9–12) measurements. Furthermore, the comparisons between the 3rd -to-1st and 2nd -to-1st were similar. When considering the total AFC, there was also no difference; however, there were larger follicles post-treatment than in the previous cycle for the first measurement (p = 0.031). Nevertheless, this difference was not observed in subsequent assessments prior to oocyte collection. When stratified by BMI class for normal-weight and obese patients, all results showed no improvement due to the treatment (Table 3 ). However, for overweight patients, the post-treatment value was significantly better than the previous cycle at the first measurement for larger follicles (p = 0.005). Table 2 The effect of intraovarian PRP on controlled ovarian stimulation Category Pre Post a P-value b Estradiol Level (E2) 1st measurement (n = 182) 95 (45, 203) 127 (54, 275) 0.015* 2nd measurement (n = 143) 291 (137, 658) 381 (189, 679) 0.096 3rd measurement (n = 118) 1063 (550, 2058) 1279 (703, 2071) 0.166 3rd to 1st ratio 12.2 (6.5, 22.1) 10.9 (5.2, 22.6) 0.782 2nd to 1st ratio 3.2 (2.3, 4.8) 3.0 (2.2, 4.3) 0.339 Ratio comparison 3.3 (2.3, 6.6) 3.2 (2.2, 5.6) 0.901 Follicular count Total (n = 188) 8 (5, 10) 8 (5, 10) 0.356 1st measurement (n = 196) Small ( 9 mm) 1 (0, 3) 2 (0, 4) 0.031* 2nd measurement (n = 158) Small ( 14 mm) 0 (0, 2) 1 (0, 2) 0.370 3rd measurement (n = 137) Small ( 18 mm) 2 (0, 4) 2 (1, 4) 0.459 Values are median (25th, 75th percentile). a The post data is made of the last post-treatment. Only patients with data for E2 on Days 3–5 after starting the COS were included. b P-values were calculated using the Wilcoxon signed rank test. * indicates a significant result (p < 0.05). Table 3 The effect of intraovarian PRP on controlled ovarian stimulation, stratified by BMI class Normal Weight Overweight Obese Category Pre Post a Pre Post a Pre Post a Estradiol Level (E2) b 1st measurement 89 (50, 200) 126 (54, 275) 101 (22, 192) 152 (63, 242) 127 (62, 255) 89 (42, 453) 2nd measurement 288 (130, 658) 384 (189, 651) 274 (129, 531) 379 (157, 690) 375 (216, 922) 408 (246, 1064) 3rd measurement 1063 (587, 2058) 1233 (763, 2187) 846 (450, 1840) 1277 (687, 1836) 1472 (1181, 2139) 1701 (851, 2888) 3rd to 1st ratio 12.8 (7.5, 23.5) 10.6 (4.7, 19.5) 9.8 (5.6, 19.8) 10.8 (5.6, 23.7) 12.9 (10.8, 22.3) 10.9 (6.1, 26.2) 2nd to 1st ratio 3.3 (2.5, 4.8) 3.0 (2.2, 4.3) 3.2 (2.3, 5.3) 2.7 (2.2, 4.2) 3.1 (2.4, 3.9) 3.6 (2.7, 5.2) Ratio comparison 3.3 (2.4, 6.7) 3.1 (2.1, 4.8) 3.1 (2.2, 5.2) 3.5 (2.3, 6.0) 4.1 (3.2, 7.0) 3.9 (2.6, 8.2) Follicular count b Total 8 (5, 11) 8 (6, 11) 7 (5, 9) 7 (5, 10) 7 (4, 9) 8 (5, 11) 1st measurement Small ( 9 mm) 1 (0, 3) 2 (0, 3) 1 (0, 3)* 2 (1, 4)* 2 (1, 3) 2 (2, 6) 2nd measurement Small ( 14 mm) 0 (0, 2) 0 (0, 2) 1 (0, 2) 1 (0, 2) 1 (0, 3) 1 (0, 2) 3rd measurement Small ( 18 mm) 2 (0, 3) 1 (0, 3) 2 (0, 4) 2 (1, 5) 2 (1, 5) 2 (1, 5) Values are median (25th, 75th percentile). a The post data is made of the last post-treatment. Only patients with data for E2 on Days 3–5 were included. b Differences between the pre and post groups were calculated using the Wilcoxon signed rank test and an * indicates a significant result (p < 0.05). Intraovarian PRP improved the availability of ova and developing embryos The efficiency of COS was assessed by the number of ova captured, the number of MII oocytes, and the ratio of MII oocytes per a patient’s ova cohort. None of these parameters demonstrated a significant effect due to intraovarian PRP treatment (Table 4 ). Moreover, the number of oocytes fertilized, independent of the size of the ova cohort, and the fertilization rate were not affected by intraovarian PRP treatment. Interestingly, the number of transferable embryos increased after intraovarian PRP treatment (p = 0.035). There was a noticeable and favorable shift in the number of cycles that did not produce any embryos for transfer after the intraovarian PRP treatment (54.2 versus 39.5%, p < 0.001) and a significant improvement in the rate of cycles in which the transferred embryos implanted (2.0 versus 14.0%, p < 0.001). This is confirmed by the higher levels associated with b-hCG (p = 0.030). When stratified by BMI class, the improvement in the number of transferable embryos was observed only in patients with normal weight (Table 5 ). Concerning embryo status, both normal-weight patients and overweight patients had significant improvement in the number of cycles that resulted in embryo implantation (normal-weight: 2.4 versus 15.0%, p < 0.001, and overweight: 0.0 versus 11.1%, p < 0.001) as well as a decrease in cycles failing to produce embryos (normal-weight: 52.7 versus 38.9%, p < 0.001 and overweight: 58.3 versus 40.7%, p < 0.001). Even though for obese patients, b-hCG was improved due to the intraovarian PRP treatment, this did not significantly improve the rate of embryo implantation, nor decrease the rate of cycles not producing an embryo. Table 4 The effect of intraovarian PRP on oocyte and embryo quality Category Pre Post a p-value b Ova captured (n = 183) 6 (3,10) 6 (3,10) 0.821 MII oocyte 5 (2, 8) 4 (2, 8) 0.502 MII/captured 75.0 (57.1, 100) 71.4 (50.0, 100) 0.332 Ova fertilized (n = 173) 4 (2, 7) 4 (2, 7) 0.330 Fertilization rate 83.3 (66.7, 100) 83.3 (66.7, 100) 0.352 Number of Transferable embryos (n = 146) 1 (0, 3) 2 (1, 3) 0.035* Day 3 embryos (n = 19) 1 (1, 2) 1 (0, 2) 0.808 Day 5 blastocyst (n = 109) 2 (1, 3) 2 (1, 3) 0.164 Embryo status (n = 299) No embryos to transfer 54.2% (162) 39.5% (118) < 0.001* Embryos, but not transferred 24.1% (72) 28.4% (85) Transferred but not implanted 19.7% (59) 18.1% (54) Transferred and implanted 2.0% (6) 14.0% (42) β-hCG (mIU/ml, n = 41) c 0.6 (0.0, 2.4) 1.0 (0.0, 112.8) 0.030* Values are presented as median (25th, 75th percentile) or as a percentage (frequency). a The post data is made of the final post-treatment. Only patients with data for the number of ova collected were included. b P-values were calculated using the Wilcoxon signed rank test. * indicates a significant result (p < 0.05). c Even though 65 patients had embryos transferred in their previous cycle and 96 patients had embryos transferred in their post-treatment cycle, only 41 patients had embryo transfers for both cycles. Table 5 The effect of intraovarian PRP on oocyte and embryo quality, stratified by BMI class Normal weight Overweight Obese Category Pre Post a Pre Post a Pre Post a Ova captured b 6 (3, 10) 6 (3, 10) 5 (3, 10) 5 (3, 8) 9 (5, 13) 9 (5, 12) MII oocyte 5 (2, 8) 4 (2, 8) 4 (2, 7) 4 (2, 6) 6 (3, 12) 6 (4, 8) MII/captured 75.0 (57.1, 100) 71.4 (50.0, 100) 75.0 (57.1, 100) 70.0 (50.0, 100) 75.0 (63.9, 100) 83.3 (62.8, 100) Ova fertilized b 4 (2, 7) 4 (2, 7) 3 (2, 6) 3 (2, 5) 6 (4, 11) 5 (3, 8) Fertilization rate 80.0 (66.7, 100) 80.0 (66.7, 100) 87.5 (66.7, 100) 81.7 (57.1, 100) 95.8 (78.6, 100) 85.4 (50.0, 100) Number of Transferable embryos b 1 (0, 3)* 2 (1, 4)* 1 (0, 2) 2 (1, 3) 2 (1, 6) 3 (2, 4) Day 3 embryos 1 (0, 1) 1 (1, 2) 1 (1, 2) 2 (0, 2) - - Day 5 blastocyst 2 (1, 3) 2 (1, 3) 1 (0, 2) 1 (1, 3) 4 (2, 7) 3 (2, 4) Embryo status b No embryos to transfer 52.7* 38.9* 58.3* 40.7* 45.8 37.5 Embryos, but not transferred 26.3* 31.7* 21.3* 25.0* 20.8 20.8 Transferred but not implanted 18.6* 14.4* 20.4* 23.1* 25.0 20.8 Transferred and implanted 2.4* 15.0* 0.0* 11.1* 8.3 20.8 β-hCG (mIU/ml) c 1.2 (0.0, 8.0) 2.0 (0.0, 163.6) 0.1 (0.0, 1.4) 0.1 (0.0, 2.7) 1.3 (0.1, 3.0)* 191.0 (0.6, 419.2)* Values are median (25th, 75th percentile) or percent (frequency). a The post data is made of the last post-treatment. Only patients with data for the number of ova collected were included. b Differences between the pre and post groups were calculated using the Wilcoxon signed rank test, and an * indicates a significant result (p < 0.05). c For each BMI class, the number of patients with embryo transfers for both pre- and post-treatment was a small subset of the overall group. Lastly, when comparing all possible ART outcomes (COS, oocyte retrieval, fertilization, embryo implantation, achieving clinical pregnancy, and live birth), intraovarian PRP treatment improves ART outcomes (Table 6 ). The ongoing pregnancy/live birth rate significantly improved (0.0 versus 10.4%, p < 0.001). Interestingly, the rate of achieving only a biochemical pregnancy or the cycle resulting in abortion was similar before and after the intraovarian PRP treatment. Similar results were observed when stratified by BMI class, with obese patients showing the highest rate. Table 6 The effect intraovarian PRP treatment has on ART outcomes, overall and stratified by BMI class All Normal weight Overweight Obese Category Pre Post Pre Post Pre Post Pre Post COS was cancelled 32.4 (97) 11.0 (33) 26.9 (45) 10.2 (17) 39.8 (43) 13.9 (15) 37.5 (9) 4.2 (1) No oocytes were retrieved 4.3 (13) 7.4 (22) 4.8 (8) 7.8 (13) 3.7 (4) 5.6 (6) 4.2 (1) 12.5 (3) No fertilization/embryos produced 16.1 (48) 16.1 (48) 18.0 (30) 17.4 (29) 15.7 (17) 15.7 (17) 4.2 (1) 8.3 (2) Embryos produced, no transfer 28.4 (85) 35.1 (105) 32.9 (55) 37.1 (62) 23.1 (25) 32.4 (35) 20.8 (5) 33.3 (8) Embryos transferred, no implant 17.1 (51) 16.7 (50) 15.6 (26) 13.2 (22) 17.6 (19) 21.3 (23) 25.0 (6) 20.8 (5) Biochemical pregnancy 0.7 (2) 1.7 (5) 0.6 (1) 1.8 (3) 0.0 (0) 1.9 (2) 4.2 (1) 0.0 (0) Aborted 1.0 (3) 1.7 (5) 1.2 (2) 1.2 (2) 0.0 (0) 2.8 (3) 4.2 (1) 0.0 (0) Ongoing pregnancy/Live birth 0.0 (0) 10.4 (31) 0.0 (0) 11.4 (19) 0.0 (0) 6.5 (7) 0.0 (0) 20.8 (5) P-value <0.001* <0.001* <0.001* 0.005* Values are presented as percentages (frequency). P-values were calculated using the Wilcoxon signed rank test, with an * indicating a significant result (p < 0.05). Discussion This study assessed the efficacy and safety of intraovarian autologous PRP used in women with a previous IVF failure due to ovarian insufficiency, while assessing if obesity affected the association. Our results support the growing body of evidence suggesting that intraovarian PRP may improve ART, particularly embryo development and implantation, even in patients with compromised ovarian reserve. One concern with IVF is that the cycle will be cancelled, mainly due to a lack of transferable embryos or embryo quality. Here, a significant decrease in IVF cycle cancellation rates was observed after PRP treatment, suggesting improved ovarian responsiveness. This is consistent with previous studies [ 9 – 11 ]. While traditional ovarian reserve markers, such as AFC and E2 levels, only showed minor improvements, the treatment resulted in a notable increase in the number of transferable embryos and a higher rate of embryo implantation and biochemical pregnancy. These results agree with recent studies reporting improved implantation and pregnancy outcomes following PRP administration in women with diminished ovarian reserve [ 12 , 13 ]. It is crucial to highlight that 19.7% of the cohort had a second post-treatment COS, with 1.7% obtaining a fourth. This suggests that for certain patients, the treatment’s effects are delayed. Future studies should ascertain which parameters could determine a potential delay in PRP’s effect, as well as which adjuvant should be applied to improve the PRP effects. One goal of ART is to isolate enough oocytes for fertilization, thereby increasing the odds of embryo implantation. Interestingly, while PRP did not significantly improve the number of oocytes collected or fertilization rates, embryo quality and the embryo implantation rate both improved, suggesting that PRP may exert its effects by enhancing the ovarian microenvironment rather than directly increasing follicle recruitment. This is supported by the known biological activity of the components of PRP (VEGF, PDGF, and TGF-β) that may promote angiogenesis and tissue regeneration within the ovarian stroma [ 3 ]. If this mechanism is correct, then using alternative treatments during the intermediate period between PRP and COS is necessary. Dehydroepiandrosterone supplementation has also been shown to improve anti-Mullerian hormone, follicle-stimulating hormone, AFC, and the ovarian reserve, with a 1.63 oocyte increase [ 14 , 15 ]. Treatment with Co-enzyme Q10 was also shown to increase the mean oocyte yield [ 16 ]. Therefore, it is speculated that supplementation with dehydroepiandrosterone or coenzyme Q10 could also be used in conjunction with intraovarian PRP. Obesity has been shown to affect the efficiency of PRP [ 6 , 7 ]. When considering obesity, differential effects of PRP were observed. Although normal-weight and overweight patients showed improvements in embryo implantation and transferability, obese patients experienced less benefit in terms of embryo development. This may reflect the known impact of obesity on growth factor composition and systemic inflammation [ 17 ], which could potentially impair the regenerative effects of PRP. Nevertheless, nutritional treatment and lifestyle intervention were shown to attenuate this effect [ 18 ]. Therefore, it may be necessary to consider making precise and well-adjusted changes to diet and/or exercise regimen before or when considering intraovarian PRP treatment. Hyperglycemia and insulin resistance may reduce the regenerative potential of PRP [ 19 ]. Elevated triglycerides and low high-density lipoprotein levels were associated with platelet hyperreactivity and chronic endothelial dysfunction [ 20 ]. In contrast, elevated cholesterol may impair PRP quality by altering platelet membrane composition and increasing pro-inflammatory mediators [ 21 ]. These findings also underscore the importance of considering the patient’s metabolic status when predicting the efficacy of PRP. However, another reason the obese group did not achieve significance, as observed in the normal-weight and overweight groups, could be due to the small sample size. Therefore, future studies should focus on this specific group. With any procedure, the potential side effects may become inhibitory. Notably, here, the procedure demonstrated a favorable safety profile, with mild to moderate ovarian bleeding being the most common complication. Severe hemoperitoneum occurred in a small proportion of cases (3.4%) but was effectively managed with culdocentesis and did not result in long-term sequelae. These findings affirm previous reports that intraovarian PRP administration is generally well tolerated [ 9 , 22 ]. This study has several limitations. First, the retrospective, single-arm design without a control group limits the ability to draw causal inferences. The self-controlled design reduces interindividual variability, but randomized controlled trials are necessary to confirm efficacy. Second, the variability in the composition of PRP among patients was not quantified or controlled. Factors such as platelet concentration, leukocyte content, and individual growth factor profiles can vary significantly and could influence treatment outcomes. Third, although COS was initiated on average 12 weeks post-PRP, the timing of stimulation may influence results. The optimal window between PRP administration and initiation of COS remains unknown, and timing differences could affect follicular recruitment and treatment efficacy. Conclusion Here, intraovarian PRP appears to be a promising option to improve ART outcomes in women with low ovarian reserve, particularly by enhancing embryo development and implantation. However, the benefit for the patient appears to be dependent on BMI and ovarian health. Further studies are needed to establish standardized protocols, clarify the mechanisms of action, and identify which patient populations are most likely to benefit from this novel therapy. Declarations Competing Interests: The authors declare that they have no conflicts of interest. Funding: The research was supported by the Ingenes Institute for Materials; however, they did not have a role in the design, collection, analysis, or interpretation of the data or in writing the manuscript. DHM received support from the National Council of Science and Technology of Mexico (CONACYT, scholarship number 790971). Ethical approval and consent to participate : The Ethics Committee of the Ingenes Institute approved this study (approval number: R06062025). Patients were contacted, and of those who agreed, written informed consent was obtained following the principles outlined in the Declaration of Helsinki. Consent for publication : Not applicable Author Contribution D Hernández-Melchor: protocol/project development, data collection and patient management, data analysis, manuscript writing/editing. JJ Suárez: data collection and patient management, revised the manuscript. LM Porchia: data analysis, manuscript writing/editing. A Romero-Jarillo: data collection and patient management. G Ortiz: data collection and patient management, revised the manuscript. I Madrazo: data collection and patient management, revised the manuscript. F Camargo: data collection and patient management, revised the manuscript. E López-Bayghen: protocol/project development, manuscript writing/editing. All authors read and approved the final manuscript. Acknowledgement We want to express our gratitude to this study’s participants and the IVF and medical staff at Ingenes. Data Availability The data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request. References Gupta S, Lodha P, Karthick MS, Tandulwadkar SR. Role of Autologous Bone Marrow-Derived Stem Cell Therapy for Follicular Recruitment in Premature Ovarian Insufficiency: Review of Literature and a Case Report of World's First Baby with Ovarian Autologous Stem Cell Therapy in a Perimenopausal Woman of Age 45 Year. Journal of human reproductive sciences. 2018;11(2):125–30. Epub 2018/08/31. doi: 10.4103/jhrs.JHRS_57_18. 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PubMed PMID: 38586113; PubMed Central PMCID: PMCPMC10994790. 10.62347/RDXA5841 von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. Int J Surg. 2014;12(12):1495–9. doi: 10.1016/j.ijsu.2014.07.013. PubMed PMID: 25046131. 10.1016/j.ijsu.2014.07.013 Sills ES, Rickers NS, Li X, Palermo GD. First data on in vitro fertilization and blastocyst formation after intraovarian injection of calcium gluconate-activated autologous platelet rich plasma. Gynecological endocrinology: the official journal of the International Society of Gynecological Endocrinology. 2018;34(9):756–60. Epub 2018/03/01. doi: 10.1080/09513590.2018.1445219. PubMed PMID: 29486615. 10.1080/09513590.2018.1445219 Sfakianoudis K, Simopoulou M, Nitsos N, Rapani A, Pantou A, Vaxevanoglou T, et al. 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PubMed PMID: 32507764; PubMed Central PMCID: PMCPMC7346073.10.18632/aging.103403 Petryk N, Petryk M. Ovarian Rejuvenation Through Platelet-Rich Autologous Plasma (PRP)-a Chance to Have a Baby Without Donor Eggs, Improving the Life Quality of Women Suffering from Early Menopause Without Synthetic Hormonal Treatment. Reproductive sciences (Thousand Oaks, Calif). 2020;27(11):1975–82. Epub 2020/07/24. doi: 10.1007/s43032-020-00266-8 . PubMed PMID: 32700285.10.1007/s43032-020-00266-8 Zhu F, Yin S, Yang B, Li S, Feng X, Wang T, et al. TEAS, DHEA, CoQ10, and GH for poor ovarian response undergoing IVF-ET: a systematic review and network meta-analysis. Reprod Biol Endocrinol. 2023;21(1):64. doi: 10.1186/s12958-023-01119-0 . PubMed PMID: 37464357; PubMed Central PMCID: PMCPMC10355041.10.1186/s12958-023-01119-0 Moslem Ahmad H, Aldahham BJM, Yakdhan Saleh M. Dehydroepiandrosterone supplementation improves diminished ovarian reserve clinical and in silico studies. Steroids. 2024;211:109490. doi: 10.1016/j.steroids.2024.109490. PubMed PMID: 39147007.10.1016/j.steroids.2024.109490 Dr. Pratibha Pasari Agarwal DMD, Dr. Sanat Pimpalkhare, Dr. Puneet Kochar, Dr. Meenal Dhabalia, Dr. Suparna Banerjee, Dr. Chaitanya Ganapule, Dr. Rohan Palshetkar, Dr. Surbhi Tomar, Dr. G Indumathi, Dr. Nidhi Singh, Dr. Sonali Gupta, Dr. KS Anamika, Dr. Anish Desai, Dr. Aditi Sharda, Dr. Harsh Patil, Dr. Manish Garg, Vikas Singh. Enhancing IVF/ICSI outcomes with Co-enzyme Q10 300 mg BID supplementation: Findings from a UNES-CO F RWE study. International Journal of Clinical Obstetrics and Gynaecology. 2024;8(5 Part B):124–9. doi: 10.33545/gynae.2024.v8.i5b.1519.10.33545/gynae.2024.v8.i5b.1519 Khanna D, Khanna S, Khanna P, Kahar P, Patel BM. Obesity: A Chronic Low-Grade Inflammation and Its Markers. Cureus. 2022;14(2):e22711. doi: 10.7759/cureus.22711. PubMed PMID: 35386146; PubMed Central PMCID: PMCPMC8967417.10.7759/cureus.22711 Spech C, Paponetti M, Mansfield C, Schmitt L, Briggs M. Biomechanical variations in children who are overweight and obese during high-impact activities: A systematic review and meta-analysis. Obes Rev. 2022;23(6):e13431. doi: 10.1111/obr.13431 . PubMed PMID: 35112792.10.1111/obr.13431 Schneider DJ. Factors contributing to increased platelet reactivity in people with diabetes. Diabetes Care. 2009;32(4):525–7. doi: 10.2337/dc08-1865 . PubMed PMID: 19336636; PubMed Central PMCID: PMCPMC2660482.10.2337/dc08-1865 Nkambule BB, Chan MV, Lachapelle AR, Grech J, Thibord F, Chen MH, et al. The association between platelet reactivity and lipoprotein levels in Framingham Heart Study participants. Thromb Res. 2023;225:103–9. doi: 10.1016/j.thromres.2023.03.013 . PubMed PMID: WOS:000987773800001.10.1016/j.thromres.2023.03.013 Dukanovic N, Obradovic S, Zdravkovic M, Durasevic S, Stojkovic M, Tosti T, et al. Lipids and Antiplatelet Therapy: Important Considerations and Future Perspectives. Int J Mol Sci. 2021;22(6). doi: 10.3390/ijms22063180 . PubMed PMID: 33804754; PubMed Central PMCID: PMCPMC8003871.10.3390/ijms22063180 Hsu CC, Hsu L, Hsu I, Chiu YJ, Dorjee S. Live Birth in Woman With Premature Ovarian Insufficiency Receiving Ovarian Administration of Platelet-Rich Plasma (PRP) in Combination With Gonadotropin: A Case Report. Frontiers in endocrinology. 2020;11:50. Epub 2020/03/07. doi: 10.3389/fendo.2020.00050 . PubMed PMID: 32140135; PubMed Central PMCID: PMCPMC7043014.10.3389/fendo.2020.00050 Additional Declarations No competing interests reported. Supplementary Files ESM1.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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1","display":"","copyAsset":false,"role":"figure","size":35818,"visible":true,"origin":"","legend":"\u003cp\u003eThe study flow chart demonstrating the selection of patients\u003c/p\u003e","description":"","filename":"Fig1.png","url":"https://assets-eu.researchsquare.com/files/rs-7586051/v1/f2ecae6a786f4a88c96ae621.png"},{"id":97894655,"identity":"15d75bf2-e225-4130-a385-2a3f8a1fda4e","added_by":"auto","created_at":"2025-12-10 15:32:52","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1089012,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7586051/v1/2b1607ad-c70b-4249-a086-728a503db92d.pdf"},{"id":95661853,"identity":"d0529787-70d7-4d3c-bab7-b56b4e369307","added_by":"auto","created_at":"2025-11-11 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However, obesity attenuates these benefits, highlighting the importance of considering metabolic status when selecting candidates for platelet-rich plasma therapy.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Introduction","content":"\u003cp\u003eCurrently, \u003cem\u003ein vitro\u003c/em\u003e fertilization (IVF) assists infertile women in increasing the possibility of achieving pregnancy. However, the biological disability of the ovaries and endometrium remains a barrier for reproductive medicine. Both organs represent significant challenges, as they are hormonally regulated tissues and undergo proliferative and secretory changes during each menstrual cycle. The lack of ova represents a limitation that has not been resolved [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eOvaries contain a limited group of primordial follicles with reproductive and endocrine functions. In women with low ovarian response, primary ovarian insufficiency, or menopause, residual dormant follicles still reside that could potentially be rescued to increase the final oocyte yield [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Therapeutic strategies to address the lack of growth and development in the ovary include drugs and surgical interventions that do not solve the problem and become the limiting factor that prevents success in assisted reproduction processes. In recent years, using cellular products or their derivatives has become a promising alternative for treating ovarian problems [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Studies have demonstrated the potential for regenerating the damaged ovarian niche through platelet-rich plasma (PRP) therapies in women with impaired ovarian reserve, resulting in significant improvements in the hormonal profiles of these patients, resumption of menstruation, and even spontaneous pregnancies or pregnancies through assisted reproductive techniques [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e\u003cp\u003ePRP is an autologous protein concentrate prepared from the patient's peripheral blood that contains a large number of growth factors and cytokines, such as vascular endothelial growth factor (VEGF), beta growth transformer (TGF-β), platelet-derived growth factor (PDGF) and epidermal growth factor (EFG), which facilitate tissue repair and regeneration as they can stimulate proliferation and angiogenesis in the tissue where they are applied [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. However, these growth factors and cytokines are affected by obesity [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], which was shown to alter the PRP isolate [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Nevertheless, the results of these different studies seem to indicate that regenerative medicine is an adequate and efficient complement to the treatment of female infertility, and, therefore, further exploration and research should be carried out to find an effective and safe treatment for this condition that affects so many couples around the world. Therefore, this study aimed to determine the effectiveness of intraovarian autologous platelet-rich plasma (PRP) in controlled ovarian stimulation and in vitro fertilization (IVF), as well as the impact of obesity on treatment outcomes.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy design and participants\u003c/h2\u003e\u003cp\u003eA chart review for a single-arm, retrospective, self-controlled study was conducted from September 2021 to January 2024, following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The cohort pool consisted of patients who were attending any clinic of the Ingenes Institute. They had to fulfill the following inclusion criteria: 1) received unilateral or bilateral intraovarian PRP injection and continued with COS after the procedure, 2) age between 25 and 49 years at the time of PRP application and had a history of at least one failed IVF cycle, and 3) had at least one normal ovary with a dominant diameter not less than 20 mm at the time of PRP application. The patients were excluded if it was documented or suspected that 1) the patient suffered from an auto-immune disease, thrombophilia, hematologic disorders, uncontrolled endocrine or other medical conditions, congenital and untreated acquired ovarian or uterine lesions, or 2) coupled with genetic and chromosomal abnormalities.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eAutologous PRP Preparation and Intraovarian Injection\u003c/h3\u003e\n\u003cp\u003eFor PRP preparation, 18 mL of venous blood was drawn from patients using six 3-mL sample collection tubes containing 3.8% sodium citrate. First, the blood samples were centrifuged at 15000 rpm for 20 minutes. Then, the serum phase was discarded, and 0.3\u0026ndash;0.5 mL of PRP was collected from each tube, resulting in a final PRP volume of 2 mL. PRP was injected into the ovaries within the next 10 minutes. PRP injection was performed under transvaginal ultrasound guidance and sedation anesthesia during the late follicular phase of the menstrual cycle bilaterally or into at least one ovary. The procedure was performed under intravenous sedation with an antibiotic (cefazolin 1 g IV) and antihemorrhagic (etamsylate 500 mg IV) coverage. Under transvaginal ultrasound guidance with a guidewire, autologous PRP (1.5-2 ml) was injected into each ovary with a 35 cm 17 G single-lumen Cook needle. The ovaries were aligned with the needle guide to avoid intervening vascular or other structures; the needle was quickly inserted without rotation deep into the central ovary. Once tip placement was confirmed, PRP was slowly injected into the cortex-medulla's mesovarium clockwise at 10 and 3 o'clock.\u003c/p\u003e\u003cp\u003eCompressive hemostasis was performed for five minutes, and ultrasound guidance (USG) was used to verify the absence of bleeding. If hemoperitoneum was observed, culdocentesis was performed to remove any free fluid in the pelvic cavity. After a second examination of the cavity, patients were taken to the recovery room and, 60 to 90 minutes later, discharged.\u003c/p\u003e\u003cp\u003eThe severity of complications was assessed and recorded by the physician. See Online Resource 1 for diagnosis criteria. For mild bleeding cases, blood was drawn in the operating room before the patient was transferred back to the recovery room. For moderate bleeding cases, the patient was observed for two hours before being discharged. Severe bleeding patients reported abdominal pain and pain radiating to the shoulder (\u0026gt;\u0026thinsp;5/10 on the VAS scale) in the recovery room. They required a culdocentesis for hemoperitoneum resolution 60\u0026ndash;90 minutes after PRP injection.\u003c/p\u003e\n\u003ch3\u003eControlled Ovarian Stimulation and Oocyte Retrieval\u003c/h3\u003e\n\u003cp\u003eAfter an average of 12 weeks, controlled ovarian stimulation was initiated. Patients underwent controlled ovarian stimulation for 10 to 14 days using gonadotropin-releasing hormone agonists and antagonists. Serum estradiol levels and ultrasound evaluation of follicular development were used to monitor the ovarian response. When the leading follicles reached a diameter of \u0026gt;\u0026thinsp;18 mm, recombinant human chorionic gonadotropin (hCG) was administered as a trigger. Oocyte retrieval was conducted 36 hours later under ultrasound guidance, where all 14\u0026ndash;18 mm follicles were aspirated.\u003c/p\u003e\u003cp\u003eIn Vitro \u003cem\u003eFertilization\u003c/em\u003e\u003c/p\u003e\u003cp\u003eAt the same time as oocyte retrieval, semen was prepared by density gradient centrifugation. Oocytes were individually decumulated, and the biologist recorded their quality and maturity status. The oocytes were inseminated by intracytoplasmic sperm injection, and fertilization was judged by forming two pronuclei 19 hours after insemination. Embryos were cultured in Global Total for Fertilization media (Cat. # LGGT-30, Life Global) and incubated at 37\u0026deg;C in a 5% O\u003csub\u003e2\u003c/sub\u003e, 8% CO\u003csub\u003e2\u003c/sub\u003e, and 87% N\u003csub\u003e2\u003c/sub\u003e atmosphere. An embryologist monitored and recorded all information about egg number and quality, semen quality, fertilization rates, embryo development, and embryo morphology for each oocyte.\u003c/p\u003e\n\u003ch3\u003eEmbryo Transfer\u003c/h3\u003e\n\u003cp\u003eWith the patient\u0026rsquo;s approval, the physician determined the cycle and the number of embryos to transfer. Patients underwent transfer with frozen-thawed blastocysts during an estrogen-primed cycle, while fresh transfers were preferred for Day 3 embryos. Embryo implantation was confirmed on Day 10 or 14 through serum β-hCG concentrations (\u0026gt;\u0026thinsp;10 mIU/ml) or by detecting a fetal heartbeat via ultrasound at 6\u0026ndash;8 weeks. The physician recorded all relevant patient demographics, IVF cycle information, implantation rates, and IVF outcomes, including pregnancies and miscarriages.\u003c/p\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eAll analyses were performed using the Statistical Package for the Social Sciences software (SPSS, v. 26.0, Chicago, IL, USA). Normality of continuous variables was determined using the Kolmogorov-Smirnov test. Differences between pre- and post-data were determined with either the McNemar test, the paired T-test, or the Wilcoxon Signed Ranks Test. The cohort was stratified into three groups by BMI: normal weight (BMI: 18.5\u0026ndash;24.9 kg/m\u0026sup2;), overweight (BMI: 25.0-29.9 kg/m\u0026sup2;), or obese (BMI: 30.0-39.9 kg/m\u0026sup2;). Unless noted otherwise, data are represented as the frequency, percent, or mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation or standard error. P-values\u0026thinsp;\u0026lt;\u0026thinsp;0.05 (two-tailed) were considered significant.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003eSelection of the participants\u003c/h2\u003e\u003cp\u003eDuring the study period, 13,319 COS cycles were performed on 9,987 patients from December 2021 to September 2024. Intraovarian PRP was applied to 2.9% of these cycles. From these cases, only 299 fulfilled the inclusion criteria and had COS (Fig.\u0026nbsp;1). Although most patients improved with COS, 19.7% had a secondary post-treatment, 4.0% had a third, and 1.7% had a fourth (the maximum allowed by the clinic). The patients\u0026rsquo; characteristics are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. It should be noted that one patient, after receiving intraovarian PRP, spontaneously became pregnant.\u003c/p\u003e\u003cp\u003e\u003cb\u003eFigure\u0026nbsp;1\u003c/b\u003e The study flow chart demonstrating the selection of patients\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCharacteristics of the population\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eValue\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSample (n)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e298\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePatient age (years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e39.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2 (min: 27, max: 49)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePartner age (years, n\u0026thinsp;=\u0026thinsp;254)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e40.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4 (min: 24, max: 64)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e24.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2 (min: 17.5, max: 40.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNormal weight (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e55.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOverweight (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eObese (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInfertility (years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2 (min: \u0026lt;1, max: 40.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrevious failed IVF cycles\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1 (min: 0, max: 10)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePatient etiology (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnilateral anexectomy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAnovulation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLow ovarian reserve\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLow ovarian response\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAdvanced maternal age\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e45.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEndometriosis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGestational failure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePremature Ovarian Failure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLow oocyte quality\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePolycystic ovary syndrome\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTubal ligation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNot reported\u0026lrm;/unknown\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePartner etiology (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNormozoospermia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAsthenoterate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAzoospermia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHydrocele\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOligoasthenoteratozoospermia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTeratozoospermia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e47.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOligoazoospermia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNot reported\u0026lrm;/ unknown\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSperm bank\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eValues are either mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard error or percentage.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eControl of surgical complications after intraovarian PRP injection\u003c/h3\u003e\n\u003cp\u003eAll possible complications were closely monitored. Mild ovarian bleeding (\u0026lt;\u0026thinsp;15 ml) was the most frequent complication after intraovarian PRP injection, presenting in 159 cases (44.9%). Moderate hemoperitoneum (greater than 50 ml) was reported in 12.5% (n\u0026thinsp;=\u0026thinsp;43) of cases and was managed within the operating room without further complications. Twelve patients (3.4%) suffered from severe hemoperitoneum (\u0026gt;\u0026thinsp;500 ml) and required a follow-up with culdocentesis to resolve the condition. Among the severe complications group, nine patients were of normal weight, and one was overweight. A detailed description of the characteristics of the complications is in the Supplementary Table.\u003c/p\u003e\u003cp\u003e\u003cem\u003eIntraovarian PRP improved COS.\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThe cycle cancellation rate was assessed using the last post-treatment cycle and compared to the patient\u0026rsquo;s previous cycle before intraovarian PRP (n\u0026thinsp;=\u0026thinsp;298). During the previous COS cycle, 32.6% resulted in the cancellation of oocyte retrieval (n\u0026thinsp;=\u0026thinsp;97); however, treatment with intraovarian PRP led to a significant decrease in COS cancellation (11.1%, n\u0026thinsp;=\u0026thinsp;33, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). When stratified by BMI class, there was a significant decrease in cycle cancellation for normal-weight patients (22.1% versus 10.2%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), overweight patients (39.8% versus 13.9%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and obese patients (37.5% versus 4.2%, p\u0026thinsp;=\u0026thinsp;0.005). Even though the rate improved in cycle cancellation (-11.9%, -25.9%, -33.3%, respectively), there was no observed interaction between BMI and treatment.\u003c/p\u003e\u003cp\u003eOf the 299 patients, only 182 had data available both before and after intraovarian PRP treatment. When considering E2 measurements, only the first measurement (Days 3\u0026ndash;5) showed a significant increase in E2 (p\u0026thinsp;=\u0026thinsp;0.015, Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). There was no effect for the 2nd (Days: 6\u0026ndash;8) and 3rd (Days: 9\u0026ndash;12) measurements. Furthermore, the comparisons between the 3rd -to-1st and 2nd -to-1st were similar. When considering the total AFC, there was also no difference; however, there were larger follicles post-treatment than in the previous cycle for the first measurement (p\u0026thinsp;=\u0026thinsp;0.031). Nevertheless, this difference was not observed in subsequent assessments prior to oocyte collection. When stratified by BMI class for normal-weight and obese patients, all results showed no improvement due to the treatment (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). However, for overweight patients, the post-treatment value was significantly better than the previous cycle at the first measurement for larger follicles (p\u0026thinsp;=\u0026thinsp;0.005).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThe effect of intraovarian PRP on controlled ovarian stimulation\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePre\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePost \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP-value \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eEstradiol Level (E2)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1st measurement (n\u0026thinsp;=\u0026thinsp;182)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e95 (45, 203)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e127 (54, 275)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.015*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2nd measurement (n\u0026thinsp;=\u0026thinsp;143)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e291 (137, 658)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e381 (189, 679)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.096\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3rd measurement (n\u0026thinsp;=\u0026thinsp;118)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1063 (550, 2058)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1279 (703, 2071)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.166\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3rd to 1st ratio\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12.2 (6.5, 22.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10.9 (5.2, 22.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.782\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2nd to 1st ratio\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.2 (2.3, 4.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.0 (2.2, 4.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.339\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRatio comparison\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.3 (2.3, 6.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.2 (2.2, 5.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.901\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eFollicular count\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal (n\u0026thinsp;=\u0026thinsp;188)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8 (5, 10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8 (5, 10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.356\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1st measurement (n\u0026thinsp;=\u0026thinsp;196)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSmall (\u0026lt;\u0026thinsp;7 mm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 (1, 5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (1, 5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.416\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGood (7\u0026ndash;9 mm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (1, 3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (1, 4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.821\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLarge (\u0026gt;\u0026thinsp;9 mm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (0, 3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (0, 4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.031*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2nd measurement (n\u0026thinsp;=\u0026thinsp;158)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSmall (\u0026lt;\u0026thinsp;12 mm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5 (2, 9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (3, 8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.628\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGood (12\u0026ndash;14 mm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (0, 2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (0, 2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.905\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLarge (\u0026gt;\u0026thinsp;14 mm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0 (0, 2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (0, 2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.370\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3rd measurement (n\u0026thinsp;=\u0026thinsp;137)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSmall (\u0026lt;\u0026thinsp;16 mm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 (3, 7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (3, 9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.588\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGood (16\u0026ndash;18 mm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (0, 2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (0, 2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.706\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLarge (\u0026gt;\u0026thinsp;18 mm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (0, 4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (1, 4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.459\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eValues are median (25th, 75th percentile).\u003c/p\u003e\u003cp\u003e\u003csup\u003ea\u003c/sup\u003e The post data is made of the last post-treatment. Only patients with data for E2 on Days 3\u0026ndash;5 after starting the COS were included.\u003c/p\u003e\u003cp\u003e\u003csup\u003eb\u003c/sup\u003e P-values were calculated using the Wilcoxon signed rank test. * indicates a significant result (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThe effect of intraovarian PRP on controlled ovarian stimulation, stratified by BMI class\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eNormal Weight\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eOverweight\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003eObese\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePre\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePost \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePre\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePost \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ePre\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ePost \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eEstradiol Level (E2)\u003c/em\u003e \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1st measurement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e89 (50, 200)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e126 (54, 275)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e101 (22, 192)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e152 (63, 242)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e127 (62, 255)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e89 (42, 453)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2nd measurement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e288 (130, 658)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e384 (189, 651)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e274 (129, 531)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e379 (157, 690)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e375 (216, 922)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e408 (246, 1064)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3rd measurement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1063 (587, 2058)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1233 (763, 2187)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e846 (450, 1840)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1277 (687, 1836)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1472 (1181, 2139)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1701 (851, 2888)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3rd to 1st ratio\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12.8 (7.5, 23.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10.6 (4.7, 19.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9.8 (5.6, 19.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e10.8 (5.6, 23.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e12.9 (10.8, 22.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e10.9 (6.1, 26.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2nd to 1st ratio\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.3 (2.5, 4.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.0 (2.2, 4.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.2 (2.3, 5.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.7 (2.2, 4.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.1 (2.4, 3.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3.6 (2.7, 5.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRatio comparison\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.3 (2.4, 6.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.1 (2.1, 4.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.1 (2.2, 5.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.5 (2.3, 6.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4.1 (3.2, 7.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3.9 (2.6, 8.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eFollicular count\u003c/em\u003e \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8 (5, 11)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8 (6, 11)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7 (5, 9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7 (5, 10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e7 (4, 9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e8 (5, 11)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1st measurement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSmall (\u0026lt;\u0026thinsp;7 mm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 (1, 6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (1, 6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 (1, 5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2 (1, 4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1 (1, 3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2 (1, 3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGood (7\u0026ndash;9 mm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (1, 4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (1, 4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (0, 3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2 (0, 3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2 (2, 6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2 (1, 6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLarge (\u0026gt;\u0026thinsp;9 mm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (0, 3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (0, 3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (0, 3)*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2 (1, 4)*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2 (1, 3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2 (2, 6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2nd measurement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSmall (\u0026lt;\u0026thinsp;12 mm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6 (3, 9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (3, 9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6 (2, 8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5 (3, 7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5 (2, 10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e6 (2, 6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGood (12\u0026ndash;14 mm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (0, 2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9 (0, 2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (0, 2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1 (0, 2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0 (0, 2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1 (0, 3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLarge (\u0026gt;\u0026thinsp;14 mm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0 (0, 2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0, 2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (0, 2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1 (0, 2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1 (0, 3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1 (0, 2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3rd measurement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSmall (\u0026lt;\u0026thinsp;16 mm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 (3, 7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (3, 9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4 (3, 7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6 (3, 7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4 (3, 6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e6 (4, 7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGood (16\u0026ndash;18 mm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (0, 3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (1, 3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (0, 2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1 (0, 2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2 (0, 5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1 (0, 5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLarge (\u0026gt;\u0026thinsp;18 mm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (0, 3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (0, 3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (0, 4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2 (1, 5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2 (1, 5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2 (1, 5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eValues are median (25th, 75th percentile).\u003c/p\u003e\u003cp\u003e\u003csup\u003ea\u003c/sup\u003e The post data is made of the last post-treatment. Only patients with data for E2 on Days 3\u0026ndash;5 were included.\u003c/p\u003e\u003cp\u003e\u003csup\u003eb\u003c/sup\u003e Differences between the pre and post groups were calculated using the Wilcoxon signed rank test and an * indicates a significant result (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eIntraovarian PRP improved the availability of ova and developing embryos\u003c/h2\u003e\u003cp\u003eThe efficiency of COS was assessed by the number of ova captured, the number of MII oocytes, and the ratio of MII oocytes per a patient\u0026rsquo;s ova cohort. None of these parameters demonstrated a significant effect due to intraovarian PRP treatment (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Moreover, the number of oocytes fertilized, independent of the size of the ova cohort, and the fertilization rate were not affected by intraovarian PRP treatment. Interestingly, the number of transferable embryos increased after intraovarian PRP treatment (p\u0026thinsp;=\u0026thinsp;0.035). There was a noticeable and favorable shift in the number of cycles that did not produce any embryos for transfer after the intraovarian PRP treatment (54.2 versus 39.5%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and a significant improvement in the rate of cycles in which the transferred embryos implanted (2.0 versus 14.0%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). This is confirmed by the higher levels associated with b-hCG (p\u0026thinsp;=\u0026thinsp;0.030). When stratified by BMI class, the improvement in the number of transferable embryos was observed only in patients with normal weight (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). Concerning embryo status, both normal-weight patients and overweight patients had significant improvement in the number of cycles that resulted in embryo implantation (normal-weight: 2.4 versus 15.0%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, and overweight: 0.0 versus 11.1%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) as well as a decrease in cycles failing to produce embryos (normal-weight: 52.7 versus 38.9%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 and overweight: 58.3 versus 40.7%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Even though for obese patients, b-hCG was improved due to the intraovarian PRP treatment, this did not significantly improve the rate of embryo implantation, nor decrease the rate of cycles not producing an embryo.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThe effect of intraovarian PRP on oocyte and embryo quality\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePre\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePost \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ep-value \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOva captured (n\u0026thinsp;=\u0026thinsp;183)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6 (3,10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (3,10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.821\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMII oocyte\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5 (2, 8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (2, 8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.502\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMII/captured\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e75.0 (57.1, 100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e71.4 (50.0, 100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.332\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOva fertilized (n\u0026thinsp;=\u0026thinsp;173)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 (2, 7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (2, 7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.330\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFertilization rate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e83.3 (66.7, 100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e83.3 (66.7, 100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.352\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNumber of Transferable embryos (n\u0026thinsp;=\u0026thinsp;146)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (0, 3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (1, 3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.035*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDay 3 embryos (n\u0026thinsp;=\u0026thinsp;19)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (1, 2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (0, 2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.808\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDay 5 blastocyst (n\u0026thinsp;=\u0026thinsp;109)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (1, 3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (1, 3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.164\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmbryo status (n\u0026thinsp;=\u0026thinsp;299)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo embryos to transfer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e54.2% (162)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e39.5% (118)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmbryos, but not transferred\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e24.1% (72)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28.4% (85)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTransferred but not implanted\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19.7% (59)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18.1% (54)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTransferred and implanted\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.0% (6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14.0% (42)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eβ-hCG (mIU/ml, n\u0026thinsp;=\u0026thinsp;41) \u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.6 (0.0, 2.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.0 (0.0, 112.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.030*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eValues are presented as median (25th, 75th percentile) or as a percentage (frequency).\u003c/p\u003e\u003cp\u003e\u003csup\u003ea\u003c/sup\u003e The post data is made of the final post-treatment. Only patients with data for the number of ova collected were included.\u003c/p\u003e\u003cp\u003e\u003csup\u003eb\u003c/sup\u003e P-values were calculated using the Wilcoxon signed rank test. * indicates a significant result (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003e\u003csup\u003ec\u003c/sup\u003e Even though 65 patients had embryos transferred in their previous cycle and 96 patients had embryos transferred in their post-treatment cycle, only 41 patients had embryo transfers for both cycles.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThe effect of intraovarian PRP on oocyte and embryo quality, stratified by BMI class\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eNormal weight\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eOverweight\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003eObese\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePre\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePost \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePre\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePost \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ePre\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ePost \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOva captured \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6 (3, 10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (3, 10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5 (3, 10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5 (3, 8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e9 (5, 13)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e9 (5, 12)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMII oocyte\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5 (2, 8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (2, 8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4 (2, 7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4 (2, 6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e6 (3, 12)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e6 (4, 8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMII/captured\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e75.0 (57.1, 100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e71.4 (50.0, 100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e75.0 (57.1, 100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e70.0 (50.0, 100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e75.0 (63.9, 100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e83.3 (62.8, 100)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOva fertilized \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 (2, 7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (2, 7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 (2, 6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3 (2, 5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e6 (4, 11)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e5 (3, 8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFertilization rate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e80.0 (66.7, 100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e80.0 (66.7, 100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e87.5 (66.7, 100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e81.7 (57.1, 100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e95.8 (78.6, 100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e85.4 (50.0, 100)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNumber of Transferable embryos \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (0, 3)*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (1, 4)*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (0, 2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2 (1, 3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2 (1, 6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3 (2, 4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDay 3 embryos\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (0, 1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (1, 2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (1, 2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2 (0, 2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDay 5 blastocyst\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (1, 3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (1, 3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (0, 2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1 (1, 3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4 (2, 7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3 (2, 4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmbryo status \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo embryos to transfer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e52.7*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e38.9*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e58.3*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e40.7*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e45.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e37.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmbryos, but not transferred\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e26.3*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e31.7*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21.3*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e25.0*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e20.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e20.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTransferred but not implanted\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18.6*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14.4*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20.4*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e23.1*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e25.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e20.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTransferred and implanted\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.4*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15.0*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.0*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e11.1*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e8.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e20.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eβ-hCG (mIU/ml) \u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.2 (0.0, 8.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.0 (0.0, 163.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.1 (0.0, 1.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.1 (0.0, 2.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.3 (0.1, 3.0)*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e191.0 (0.6, 419.2)*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eValues are median (25th, 75th percentile) or percent (frequency).\u003c/p\u003e\u003cp\u003e\u003csup\u003ea\u003c/sup\u003e The post data is made of the last post-treatment. Only patients with data for the number of ova collected were included.\u003c/p\u003e\u003cp\u003e\u003csup\u003eb\u003c/sup\u003e Differences between the pre and post groups were calculated using the Wilcoxon signed rank test, and an * indicates a significant result (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003e\u003csup\u003ec\u003c/sup\u003e For each BMI class, the number of patients with embryo transfers for both pre- and post-treatment was a small subset of the overall group.\u003c/p\u003e\u003cp\u003eLastly, when comparing all possible ART outcomes (COS, oocyte retrieval, fertilization, embryo implantation, achieving clinical pregnancy, and live birth), intraovarian PRP treatment improves ART outcomes (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e). The ongoing pregnancy/live birth rate significantly improved (0.0 versus 10.4%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Interestingly, the rate of achieving only a biochemical pregnancy or the cycle resulting in abortion was similar before and after the intraovarian PRP treatment. Similar results were observed when stratified by BMI class, with obese patients showing the highest rate.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThe effect intraovarian PRP treatment has on ART outcomes, overall and stratified by BMI class\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eAll\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eNormal weight\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003eOverweight\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003eObese\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePre\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePost\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePre\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePost\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ePre\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ePost\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003ePre\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003ePost\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCOS was cancelled\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e32.4 (97)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11.0 (33)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e26.9 (45)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e10.2 (17)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e39.8 (43)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e13.9 (15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e37.5 (9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e4.2 (1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo oocytes were retrieved\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.3 (13)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.4 (22)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.8 (8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7.8 (13)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.7 (4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e5.6 (6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e4.2 (1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e12.5 (3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo fertilization/embryos produced\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16.1 (48)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16.1 (48)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e18.0 (30)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e17.4 (29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e15.7 (17)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e15.7 (17)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e4.2 (1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e8.3 (2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmbryos produced, no transfer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28.4 (85)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e35.1 (105)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e32.9 (55)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e37.1 (62)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e23.1 (25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e32.4 (35)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e20.8 (5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e33.3 (8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmbryos transferred, no implant\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17.1 (51)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16.7 (50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15.6 (26)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e13.2 (22)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e17.6 (19)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e21.3 (23)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e25.0 (6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e20.8 (5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBiochemical pregnancy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.7 (2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.7 (5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.6 (1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.8 (3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.9 (2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e4.2 (1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.0 (0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAborted\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.0 (3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.7 (5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.2 (2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.2 (2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2.8 (3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e4.2 (1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.0 (0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOngoing pregnancy/Live birth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10.4 (31)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e11.4 (19)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e6.5 (7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e20.8 (5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;0.001*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;0.001*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;0.001*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.005*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eValues are presented as percentages (frequency). P-values were calculated using the Wilcoxon signed rank test, with an * indicating a significant result (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study assessed the efficacy and safety of intraovarian autologous PRP used in women with a previous IVF failure due to ovarian insufficiency, while assessing if obesity affected the association. Our results support the growing body of evidence suggesting that intraovarian PRP may improve ART, particularly embryo development and implantation, even in patients with compromised ovarian reserve.\u003c/p\u003e\u003cp\u003eOne concern with IVF is that the cycle will be cancelled, mainly due to a lack of transferable embryos or embryo quality. Here, a significant decrease in IVF cycle cancellation rates was observed after PRP treatment, suggesting improved ovarian responsiveness. This is consistent with previous studies [\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. While traditional ovarian reserve markers, such as AFC and E2 levels, only showed minor improvements, the treatment resulted in a notable increase in the number of transferable embryos and a higher rate of embryo implantation and biochemical pregnancy. These results agree with recent studies reporting improved implantation and pregnancy outcomes following PRP administration in women with diminished ovarian reserve [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. It is crucial to highlight that 19.7% of the cohort had a second post-treatment COS, with 1.7% obtaining a fourth. This suggests that for certain patients, the treatment\u0026rsquo;s effects are delayed. Future studies should ascertain which parameters could determine a potential delay in PRP\u0026rsquo;s effect, as well as which adjuvant should be applied to improve the PRP effects.\u003c/p\u003e\u003cp\u003eOne goal of ART is to isolate enough oocytes for fertilization, thereby increasing the odds of embryo implantation. Interestingly, while PRP did not significantly improve the number of oocytes collected or fertilization rates, embryo quality and the embryo implantation rate both improved, suggesting that PRP may exert its effects by enhancing the ovarian microenvironment rather than directly increasing follicle recruitment. This is supported by the known biological activity of the components of PRP (VEGF, PDGF, and TGF-β) that may promote angiogenesis and tissue regeneration within the ovarian stroma [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. If this mechanism is correct, then using alternative treatments during the intermediate period between PRP and COS is necessary. Dehydroepiandrosterone supplementation has also been shown to improve anti-Mullerian hormone, follicle-stimulating hormone, AFC, and the ovarian reserve, with a 1.63 oocyte increase [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Treatment with Co-enzyme Q10 was also shown to increase the mean oocyte yield [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Therefore, it is speculated that supplementation with dehydroepiandrosterone or coenzyme Q10 could also be used in conjunction with intraovarian PRP.\u003c/p\u003e\u003cp\u003eObesity has been shown to affect the efficiency of PRP [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. When considering obesity, differential effects of PRP were observed. Although normal-weight and overweight patients showed improvements in embryo implantation and transferability, obese patients experienced less benefit in terms of embryo development. This may reflect the known impact of obesity on growth factor composition and systemic inflammation [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], which could potentially impair the regenerative effects of PRP. Nevertheless, nutritional treatment and lifestyle intervention were shown to attenuate this effect [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Therefore, it may be necessary to consider making precise and well-adjusted changes to diet and/or exercise regimen before or when considering intraovarian PRP treatment. Hyperglycemia and insulin resistance may reduce the regenerative potential of PRP [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Elevated triglycerides and low high-density lipoprotein levels were associated with platelet hyperreactivity and chronic endothelial dysfunction [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. In contrast, elevated cholesterol may impair PRP quality by altering platelet membrane composition and increasing pro-inflammatory mediators [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. These findings also underscore the importance of considering the patient\u0026rsquo;s metabolic status when predicting the efficacy of PRP. However, another reason the obese group did not achieve significance, as observed in the normal-weight and overweight groups, could be due to the small sample size. Therefore, future studies should focus on this specific group.\u003c/p\u003e\u003cp\u003eWith any procedure, the potential side effects may become inhibitory. Notably, here, the procedure demonstrated a favorable safety profile, with mild to moderate ovarian bleeding being the most common complication. Severe hemoperitoneum occurred in a small proportion of cases (3.4%) but was effectively managed with culdocentesis and did not result in long-term sequelae. These findings affirm previous reports that intraovarian PRP administration is generally well tolerated [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThis study has several limitations. First, the retrospective, single-arm design without a control group limits the ability to draw causal inferences. The self-controlled design reduces interindividual variability, but randomized controlled trials are necessary to confirm efficacy. Second, the variability in the composition of PRP among patients was not quantified or controlled. Factors such as platelet concentration, leukocyte content, and individual growth factor profiles can vary significantly and could influence treatment outcomes. Third, although COS was initiated on average 12 weeks post-PRP, the timing of stimulation may influence results. The optimal window between PRP administration and initiation of COS remains unknown, and timing differences could affect follicular recruitment and treatment efficacy.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eHere, intraovarian PRP appears to be a promising option to improve ART outcomes in women with low ovarian reserve, particularly by enhancing embryo development and implantation. However, the benefit for the patient appears to be dependent on BMI and ovarian health. Further studies are needed to establish standardized protocols, clarify the mechanisms of action, and identify which patient populations are most likely to benefit from this novel therapy.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eCompeting Interests:\u003c/strong\u003e\u003cp\u003eThe authors declare that they have no conflicts of interest.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e\u003cp\u003eThe research was supported by the Ingenes Institute for Materials; however, they did not have a role in the design, collection, analysis, or interpretation of the data or in writing the manuscript. DHM received support from the National Council of Science and Technology of Mexico (CONACYT, scholarship number 790971).\u003c/p\u003e\u003cp\u003e\u003cem\u003eEthical approval and consent to participate\u003c/em\u003e: The Ethics Committee of the Ingenes Institute approved this study (approval number: R06062025). Patients were contacted, and of those who agreed, written informed consent was obtained following the principles outlined in the Declaration of Helsinki.\u003c/p\u003e\u003cp\u003e\u003cem\u003eConsent for publication\u003c/em\u003e: Not applicable\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eD Hern\u0026aacute;ndez-Melchor: protocol/project development, data collection and patient management, data analysis, manuscript writing/editing. JJ Su\u0026aacute;rez: data collection and patient management, revised the manuscript. LM Porchia: data analysis, manuscript writing/editing. A Romero-Jarillo: data collection and patient management. G Ortiz: data collection and patient management, revised the manuscript. I Madrazo: data collection and patient management, revised the manuscript. F Camargo: data collection and patient management, revised the manuscript. E L\u0026oacute;pez-Bayghen: protocol/project development, manuscript writing/editing. All authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe want to express our gratitude to this study\u0026rsquo;s participants and the IVF and medical staff at Ingenes.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGupta S, Lodha P, Karthick MS, Tandulwadkar SR. Role of Autologous Bone Marrow-Derived Stem Cell Therapy for Follicular Recruitment in Premature Ovarian Insufficiency: Review of Literature and a Case Report of World's First Baby with Ovarian Autologous Stem Cell Therapy in a Perimenopausal Woman of Age 45 Year. Journal of human reproductive sciences. 2018;11(2):125\u0026ndash;30. 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PubMed PMID: 32140135; PubMed Central PMCID: PMCPMC7043014.10.3389/fendo.2020.00050\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Assisted reproductive technology, obesity, ovarian regeneration, PRP, poor ovarian response","lastPublishedDoi":"10.21203/rs.3.rs-7586051/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7586051/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e\u003cp\u003eTo evaluate the effectiveness of intraovarian autologous platelet-rich plasma (PRP) on controlled ovarian stimulation (COS) and in vitro fertilization (IVF) outcomes, and to assess the potential modifying role of obesity on treatment response.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis retrospective self-controlled study included 299 women (25\u0026ndash;49 years) with a history of at least one failed IVF cycle who received intraovarian PRP between September 2021 and January 2024. Patients underwent COS and IVF post-treatment. Outcomes included hormonal response, cycle cancellation rate, number of retrieved oocytes, embryo development, and pregnancy rates. Using BMI, patients were stratified into normal weight (18.5\u0026ndash;24.9 kg/m\u0026sup2;), overweight (25.0-29.9 kg/m\u0026sup2;), and obese (\u0026ge;\u0026thinsp;30.0 kg/m\u0026sup2;).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eFollowing PRP treatment, the COS cycle cancellation rate significantly decreased from 32.6% to 11.1% (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Improvements were seen across all BMI categories. The number of transferable embryos increased (p\u0026thinsp;=\u0026thinsp;0.035), and implantation rates rose from 2.0% to 14.0% (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). A significant increase in ongoing pregnancy/live birth rates was observed (0.0% vs. 10.4%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Obese patients showed improvement but had less favorable implantation outcomes. PRP was generally safe, though mild to moderate bleeding occurred in a subset of patients.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eIntraovarian PRP appears to enhance COS and IVF outcomes, particularly by improving embryo development and implantation. However, obesity may attenuate these effects. Further randomized controlled trials are needed to confirm efficacy and optimize patient selection and treatment timing.\u003c/p\u003e","manuscriptTitle":"Efficacy of Autologous Platelet-Rich Plasma in Ovarian Stimulation and In Vitro Fertilization: Impact of Obesity on Reproductive Outcomes","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-11 16:17:46","doi":"10.21203/rs.3.rs-7586051/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7795d7a4-12f6-4b5d-9127-5a041cd5989b","owner":[],"postedDate":"November 11th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-12-08T15:08:46+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-11 16:17:46","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7586051","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7586051","identity":"rs-7586051","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}