Current possibilities of nonhormonal ovarian function activation with low ovarian reserve


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Abstract

Patients with low ovarian reserve occupy a significant place in the pattern of an infertile marriage. Ovarian reserve is a clinical phenomenon caused by age, genetics, autoimmune mechanisms, and environmental factors. This term is used to describe the reproductive potential and to predict a response to controlled ovulation stimulation in assisted reproductive technology programs. According to a variety of data, the prevalence of low ovarian reserve varies from 5.6 to 35.1%. To date, little is known about the causes of diminished ovarian reserve and its risk factors except the iatrogenic factors associated with surgical intervention. From the clinical point of view, the low ovarian reserve group includes female patients with a poor ovarian response, those with premature ovarian failure, and late reproductive-aged women. Current strategies for controlled ovarian stimulation focus on growing follicles; in this case, dormant primordial follicles cannot be activated by the currently known stimulation protocols. The most successful outcome in patients with a poor response or ovarian insufficiency is pregnancy achieved using donor oocytes, but a large majority of the women think badly of these programs and are looking for alternative solutions. The literature review presents an update on the possibilities, features, and side effects of technologies for nonhormonal ovarian function activation with low ovarian reserve: autologous intraovarian platelet rich plasma (PRP) therapy, stem cell injections, and surgical ovarian activation. Conclusion: Heterogeneity in study designs and data analysis does not yet allow the effectiveness of the technologies under consideration to be evaluated. For none of them, the exact mechanisms of action are still unknown. However, in our opinion, intraovarian PRP injection is the safest and most effective therapy. At the same time, the features of the technology and its effectiveness in various patient cohorts require further careful study.

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About the authors

Ekaterina D. Dubinskaya

RUDN University

Dr. Med. Sci., Professor of the Department of Obstetrics and Gynecology with a Course of Perinatology

Alexander S. Gasparov

RUDN University

Dr. Med. Sci., Professor of the Department of Obstetrics, Gynecology and Reproductive Medicine, Faculty of Continuous Medical Education

Nadezhda M. Krylova

RUDN University

Assistant at the Department of Obstetrics, Gynecology and Reproductive Medicine, Faculty of Continuing Medical Education

Natalya V. Dmitrieva

RUDN University

Email: dmitrieva-doc@yandex.ru
Ph.D., reproductologist at the Clinic "I am healthy”, Researcher at the clinical base of the Department of Obstetrics, Gynecology and Reproductive Medicine

Elizaveta V. Alyoshkina

RUDN University

Assistant of the Department of Obstetrics, Gynecology and Reproductive Medicine, Faculty of Continuing Medical Education

Irina A. Ryazanova

RUDN University

Assistant of the Department of Obstetrics, Gynecology and Reproductive Medicine, Faculty of Continuing Medical Education

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