(287) Transvaginal Ovarian Drilling (TVOD) Combined with Platelet-Rich Plasma (PRP) Ovarian Rejuvenation Improves Euploid and Transferable Embryo Yield in Low Prognosis IVF Patients Compared to Controls

Carolyn Robb1; Sarah C. Rubin1; Kaleb Noruzi1, Martin D. Keltz1,2

1. New York Medical College, Department of Obstetrics and Gynecology Westchester Medical Center Center, Valhalla, NY, USA

2. Westmed Reproductive Services, Summit Health, Purchase, NY, USA
 

 

 

 

Abstract Text:

Transvaginal Ovarian Drilling (TVOD) Combined with Platelet-Rich Plasma (PRP) Ovarian Rejuvenation Improves Euploid and Transferable Embryo Yield in Low Prognosis IVF Patients Compared to Controls

Carolyn Robb1; Sarah C. Rubin1; Kaleb Noruzi1, Martin D. Keltz1,2

1. New York Medical College, Department of Obstetrics and Gynecology Westchester Medical Center Center, Valhalla, NY, USA

2. Westmed Reproductive Services, Summit Health, Purchase, NY, USA

We have previously shown that transvaginal ovarian drilling (TVOD) vastly improves the live birth rate and euploid embryo rate in patients with PCOS with prior poor IVF outcomes. Intra-ovarian platelet-rich plasma (PRP) has been suggested to improve blastocyst and euploidy rates in non-PCOS poor prognosis patients. This is the first study to analyze the combined effect of TVOD and PRP on euploid plus transferable mosaic embryo yield in poor prognosis IVF patients.

We present a single-institution, retrospective case-control study between July 2022 and December 2024. All patients who had combined TVOD+PRP for ovarian rejuvenation (n=25) performed prior to a repeat freeze-all Preimplantation Genetic Testing for Aneuploidy (PGT-A) IVF cycle were compared to all controls (n=339) with one or fewer euploid embryos in their first IVF cycle who underwent a second freeze-all PGT-A cycle with no change in protocol. Statistics employed paired t-test and Wilcoxon rank sum for comparison to control. TVOD+PRP was performed with transvaginal ultrasound guidance under propofol anesthesia: a 17-gauge retrieval needle under suction punctured each ovary, drilling the stroma proximally to distally while moving laterally to medially 50 to 100 times. After TVOD, 2-4 mL of autologous PRP was injected into each ovarian stroma. The primary outcome was euploid and transferable mosaic embryo yield. Secondary outcomes were blastocyst yield and aneuploidy rate.

Mean age and Anti-Mullerian Hormone (AMH) levels of the TVOD+PRP group (n=25) and control group (n=339) were 37.4±3.2 and 38.2±3.9 (p=0.11) and 2.4±2.9 ng/mL and 1.9±1.8 ng/mL (p=0.78) respectively. Following TVOD+PRP, there was an increase in blastocyst (2.12±1.5 to 3.36±2.9, p=0.04), euploid (0.48±0.6 to 1.84±2.1, p=0.002), and transferable embryo (0.6±0.7 to 2.2±2.4, p=0.002) yield and decrease in percent aneuploidy (56±43% to 28±31%, p=0.009). With AMH < 1, aneuploidy decreased (62±46% to 13±22% p=0.04), but there was no change in euploid yield. For AMH >1, the blastocyst (2.8±1.4 to 5±2.5, p=0.01), euploid (0.67±0.62 to 2.9±2.1, p=0.003), and transferable embryo (0.9±0.7 to 3.4±2.4, p=0.003) yields were all significantly increased. Controls also had significant increases in oocytes, embryos, blastocysts, euploids, and transferable embryos; we then assessed the change from first to second cycles in treatment versus controls. When compared to controls, TVOD+PRP significantly improved euploid (p=0.04) and transferable embryo (p=0.02) yield and decreased percent aneuploidy (p=0.03). For AMH < 1, only aneuploidy was reduced (p=0.009). For AMH >1, both euploid (p=0.003) and transferable embryo (p=0.003) yields were significantly increased when compared to controls.

In conclusion, TVOD followed by PRP increased euploid and transferable embryos and decreased aneuploidy rate for poor prognosis patients when compared to controls. Markedly increased transferable embryo yield following TVOD+PRP may improve the live birth rate per retrieval. We suspect these findings result from improved blood flow and oxygenation within the ovary, however, further studies are necessary to elucidate this process.