Ovario-protective effect of intra-ovarian injection of platelet rich plasma (PRP) after laparoscopic cystectomy of ovarian endometrioma: a randomized control trial.

OBJECTIVE: This study aimed to evaluate the effectiveness of Platelet-Rich Plasma (PRP) in preserving ovarian reserve in patients with endometriosis who underwent laparoscopic cystectomy. METHOD: A randomized, parallel, open-label phase II clinical trial was conducted. A total of 38 eligible women aged 20 to 35 years with ovarian endometrioma, candidates for laparoscopic ovarian cystectomy, were randomly assigned to either the PRP group (n = 20) or the control group (n = 18). The PRP group received an intra-ovarian injection of 2-4 cc of PRP immediately after cystectomy, while the control group underwent cystectomy without additional intervention. The primary outcome was the change in serum anti-Müllerian hormone (AMH) levels six months post-intervention. The secondary outcome was the antral follicle count (AFC) six months post-intervention. Short-term adverse effects were monitored within the first 48 h after the procedure. RESULTS: The PRP group showed a negligible change in AMH levels (mean difference 0.05, 95% CI: -0.17 to 0.26), while the control group exhibited a significant decline (mean difference - 0.24, 95% CI: -0.5 to 0.12). The adjusted mean difference between the groups was - 0.308 (-0.626 to -0.01), tending toward statistical significance (P = 0.057). No significant differences in AFC were observed between the groups, and no short-term adverse events were reported. CONCLUSIONS: This phase II exploratory trial found a near-significant trend toward preservation of AMH levels with intra-ovarian PRP injection after endometrioma surgery. While these findings are not definitive, they support the feasibility and safety of the approach and warrant further evaluation in larger, controlled trials. TRIAL REGISTRATION: The study was prospectively registered in the Iranian Registry of Clinical Trials under the number IRCT20191123045476N3 on December 1, 2021 ( https://irct.behdasht.gov.ir/trial/58688 ).