Combination of CO2 laser and Platlet Rich Plasma: A Safe Treatment as a Possible New Frontier for Poor Ovarian Responders


  • Antonella Clara Starace Department of Pathophysiology of Human Reproduction, IVF Center, Santa Margherita Hospital, Cortona, Italy
  • Carlo Mirabella Department of transfusion medicine, Regenerative Therapy Center, Santa Margherita Hospital, Cortona, Italy
  • Stefania Magnolfi Department of Pathophysiology of Human Reproduction, IVF Center, Santa Margherita Hospital, Cortona, Italy
  • Ciro Sommella Department of Obstetrics and Gynecology, San Donato Hospital, Arezzo, Italy
  • Francesca Ciociola Department of Pathophysiology of Human Reproduction, IVF Center, Santa Margherita Hospital, Cortona, Italy
  • Maria Giulia Massaro Department of Pathophysiology of Human Reproduction, IVF Center, Santa Margherita Hospital, Cortona, Italy
  • Silvia Gatto Department of Pathophysiology of Human Reproduction, IVF Center, Santa Margherita Hospital, Cortona, Italy
  • Luca Mencaglia Department of Pathophysiology of Human Reproduction, IVF Center, Santa Margherita Hospital, Cortona, Italy


Platlet Rich Plasma, Decreased Ovarian Reserve, CO2 Laser, Poor Responder


The ovarian reserve defines the number of antral follicles in the woman's ovaries. Female gametes from the twentieth week of intrauterine life undergo a process of inexorable progressive exhaustion and the follicles present at the birth continue to reduce in number, due to a degenerative phenomena that determine its loss. The decrease in ovarian reserve is associated with a reduced fertility and this matter represents the major challenge in reproductive medicine. The interventions that support the regeneration of gonads represent the new frontier. This study intends to propose a method to induce a regeneration of ovarian response in ovarian tissue of patients with poor response and to optimise the recruitment of pre-existing dormant follicles to improve the ovarian stimulation in vitro fertilization cycle. We enrolled patients of childbearing age with poor ovarian reserve diagnosed with AFC <5-7 follicles and /or altered hormonal levels (FSH> 12 mIU / ml; AMH <0.5-1,1 ng / ml) and / or with at least one IVF cycle that has given failed oocytes recovery. The main scientific and technical innovation of the study is the combination of treatment with CO2 laser (microdissection on both ovaries performed by laparoscopy) and injection of platlet rich plasma on ovarian subcortical tissue under direct vision. DUOSTIM (double stimulation) to start in a month was planned for all enrolled patients. The aim is to demonstrate that the experimental treatment has a safety profile, with no risk for patients health. No patients manifested any adverse reactions and complications. Data on the effect on the fertility restoration are not yet avilable because patients follow up has not yet ended, thus we will publish them in the near future. 


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2021-12-31 — Updated on 2022-04-22