#145 : Effect of Intra-Ovarian Instillation of Autologous Platelet Rich Plasma on Live Birth Rate in POSEIDON 3 versus POSEIDON 4 Group: A Prospective Follow-Up Study

Background and Aims: Various anecdotal cases have been reported regarding platelet rich plasma (PRP), demonstrating successful pregnancy outcomes. But the data still remains elusive, especially for women of Asian ethnicity, who have a rapid decline in ovarian reserve when compared to the Caucasian population. We aim to study the effect of intra-ovarian PRP on live birth rate (LBR) in POSEIDON-3 versus POSEIDON-4 group.

Method: Prospective interventional study conducted at tertiary care institute (July 2020-April 2022). 72-women between 20-40 years with idiopathic poor ovarian reserve (AMH$<$1.2 ng/ml; AFC$<$5) and a normal uterine cavity were enrolled. A 1.5 ml-PRP prepared from 30 ml venous-blood, was instilled in each ovarian stroma between day 6-10 of menses with 3-consecutive months follow-up to assess ovarian-reserve parameters (FSH, AMH, AFC). Patients showing improvement (AFC$\ge$ 5) were enrolled in antagonist-IVF cycles and categorised into two groups: POSEIDON-3 vs 4 groups. Paired/signrank test and Independent/ranksum test compared clinical parameters between the two-groups.

Results: Out of 72 participants, 16.67% responded in 1 ${}^{st}$  month of follow-up (AFC: 5 vs 3, p$<$0.001), 43% in 2 ${}^{nd}$  month (AFC: 6 vs 3, p$<$0.001) and 12.5% in 3 ${}^{rd}$  month (AFC:4 vs 3, p$<$0.001). 20 participants showed no improvement. Excluding one, 43 underwent antagonist-cycle. Although number of oocytes retrieved was similar (6.35 ± 1.83 vs 5.75 ± 1.35, p=0.21), the dose of HMG requirement was higher in POSEIDON-4 (1450 ± 96.53 vs 1190.3 ± 66.49, p=0.04) thus depicting the effect of advanced age. There was no significant difference in dose of rFSH requirement (2705.6 ± 48.93 vs 2737 ± 54.74, p=0.71), fertilisation rate (60.86% vs 57.86%, p=0.66), CPR (25% vs 25.8%, p=0.95) and LBR (22.6% vs 16.66%, p=0.66) between the two-groups.

Conclusion: Intra-ovarian PRP improves the LBR in low-prognosis patients irrespective of age. PRP improves the ovarian reserve which translates into better reproductive outcomes in a population of women who were planned and counselled for donor-oocyte IVF.