What is the mechanism of Platelet-Rich Plasma (PRP) intraovarian treatment?

Mechanism of Intraovarian Platelet-Rich Plasma (PRP)

Intraovarian PRP works by delivering concentrated growth factors and cytokines from platelet α-granules that promote local angiogenesis, stem cell recruitment, cell migration, proliferation, and differentiation, while creating a fibrin scaffold that serves as a temporary matrix for tissue repair. 1

Core Biological Mechanisms

Growth Factor Release and Cellular Signaling:

• Upon platelet activation, PRP releases bioactive proteins and growth factors that directly stimulate tissue regeneration processes 1
• These growth factors promote local angiogenesis (new blood vessel formation) in ovarian tissue 1
• The concentrated cytokines facilitate stem cell homing and recruitment to the ovarian microenvironment 2

Cellular Effects:

• PRP stimulates cell migration, proliferation, and differentiation within ovarian tissue 1
• The treatment promotes deposition of matrix proteins, particularly collagen, which supports structural tissue repair 1
• In PCOS animal models, intraovarian PRP improved folliculogenesis, enhanced ovarian antioxidant potential, and corrected serum hormonal imbalances 3

Fibrin Scaffold Formation:

• Activated platelets create a fibrin scaffold that acts as a temporary three-dimensional matrix for tissue repair 1
• This scaffold provides structural support for cellular regeneration and tissue remodeling 1

Hypothesized Ovarian-Specific Mechanisms

Gene Expression Modulation:

• The infusion of cytokines and growth factors may exhibit local effects that change expression of genes important in folliculogenesis and steroidogenesis 3
• This genetic modulation could partially restore normal ovarian function in women with ovarian dysfunction 3

Anti-Inflammatory Effects:

• PRP administration may decrease local inflammation within ovarian tissue 3
• Reduced inflammation could improve the ovarian microenvironment for follicle development 3

Follicle Stimulation:

• The mechanism appears to stimulate follicle production in women with various forms of ovarian dysfunction 4
• Clinical observations suggest improved follicular recruitment following PRP administration 5

Important Caveats

Lack of Standardization:

• The field suffers from poor standardization in preparation methods, terminology, purity, content, and quality of PRP products 6
• Differences in preparation techniques (g-force, centrifugation time, activation method) result in significant variations in platelet yields, concentration, purity, viability, and activation status 6
• This variability directly impacts clinical efficacy and makes mechanism elucidation challenging 6

Evidence Limitations:

• While the hypothetical mechanisms are biologically plausible, clinical trials have been conducted without clear definition or quantification of PRP biological properties 6
• The International Society on Thrombosis and Haemostasis emphasizes that further studies on the mechanism of platelet tissue regeneration are needed to elucidate the best combination of bioactive factors 7
• Current evidence for ovarian applications remains preliminary, with most data from small case series rather than controlled trials 2, 8