Purpose: To report successful in vivo fertilization in four out of five women with diminished ovarian reserve (DOR) after transuterine perfusion of the ovaries and pelvis with autologous platelet-rich plasma (PRP).

Methods: Patients that exhibited DOR (defined as AMH <1.1 ng/mL and antral follicular count of < 7 follicles) and had failed in vitro fertilization and/or artificial insemination in the past year were offered transuterine perfusion of PRP with oral letrozole and timed intercourse as an alternative therapy. Five patients accepted the protocol. Patients took 10 mg of letrozole orally from day 3 to day 7 of the menstrual cycle to increase chances of ovulation. They underwent one transuterine perfusion of the pelvis during the follicular phase of each cycle with a 10 mL volume of fresh autologous platelet-rich plasma under ultrasound guidance to allow periovarian spillage from the fallopian tubes.

Result: In 4 out of 5 cases patients conceived without the need for in vitro intervention. Three patients had a successful pregnancy. One patient had a miscarriage at 19 weeks. One patient did not conceive within the four months of observation.

Conclusion: Delivering platelet-rich plasma to the ovaries by transuterine perfusion may be a safe and cost-effective approach to enhance fertility in women with impaired ovarian reserve undergoing fertility therapies.