Intraovarian Platelet-Rich Plasma for Women with Diminished Ovarian Reserve: A Systematic Review and Meta-Analysis

Objectives: To systematically evaluate the efficacy and safety of intraovarian platelet-rich plasma (PRP) administration in women with diminished ovarian reserve (DOR) and related conditions, given the growing clinical interest and the conflicting evidence from uncontrolled and controlled studies. Methods: This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Comprehensive searches were performed in PubMed, Web of Science, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), and Scopus up to January 2026. Eligible studies included randomized controlled trials (RCTs), prospective cohort studies, and before-after studies investigating PRP-based interventions in women diagnosed with DOR, premature ovarian insufficiency (POI), or poor ovarian response (POR). Given the limited availability of controlled data, these populations were analyzed together with cautious interpretation. Study quality was assessed using the Joanna Briggs Institute (JBI) checklists and the Critical Appraisal Skills Programme (CASP) tool for RCTs. Pooled estimates were calculated using random- or fixed-effects models depending on heterogeneity (I²). Results: Nineteen studies involving 1794 women were included, of which two were randomized controlled trials. In single-arm and before-after analyses, PRP administration was associated with increases in serum anti-Müllerian hormone (AMH) levels and antral follicle count (AFC), as well as a reduction in serum follicle-stimulating hormone (FSH). In addition, the number of metaphase II (MII) oocytes retrieved and transferable embryos increased following PRP treatment. However, pooled analyses of controlled studies, including RCTs, did not demonstrate consistent improvements in mature oocyte yield compared with control groups. In single-arm analyses, the pooled clinical pregnancy rate and live birth rate following PRP treatment were 15.5% (95% CI: 11.1-21.2%) and 10.7% (95% CI: 6.7-16.6%), respectively. No major procedure-related adverse events were reported across included studies. Conclusions: In conclusion, intraovarian PRP is associated with improvements in ovarian reserve markers such as AMH and AFC in uncontrolled studies. However, evidence from randomized controlled trials does not demonstrate a consistent benefit in pregnancy and live birth. Well-designed RCTs with standardized protocols are needed before clinical recommendation.