Efficacy of intraovarian autologous platelet-rich plasma in women with poor ovarian reserve or ovarian insufficiency: a meta-analysis of randomized controlled trials

Background Poor ovarian reserve and ovarian insufficiency pose major challenges in reproductive medicine, with limited effective therapeutic options. Intraovarian autologous platelet-rich plasma (PRP) has shown potential benefits, but its efficacy remains uncertain based on current randomized controlled trials (RCTs). Methods This review followed PRISMA guidelines and was registered in PROSPERO (CRD420251233432). We systematically searched PubMed, Cochrane Central, Embase, CNKI, VIP, and Wanfang up to November 22, 2025, for randomized controlled trials of intraovarian autologous PRP in women with diminished ovarian reserve or ovarian insufficiency. Meta-analyses were performed using Stata 16, with heterogeneity assessed by the I² statistic. Risk of bias and study quality were evaluated using the Cochrane RoB 2 tool and the PEDro scale. Primary outcomes included serum anti-Müllerian hormone (AMH), follicle-stimulating hormone (FSH), antral follicle count (AFC), and pregnancy rates. Result(s) This meta-analysis included seven RCTs involving 422 women with poor ovarian reserve or ovarian insufficiency/failure. PRP treatment was associated with significant improvements in several ovarian reserve-related parameters: AFC increased (MD = 0.81, 95% CI 0.31 to 1.30; I² = 41.63%), AMH increased (SMD = 0.91, 95% CI 0.41 to 1.42; I² = 54.32%), FSH decreased (MD = -5.72, 95% CI -7.03 to -4.41; I² = 0.00%), and estradiol increased (MD = 26.03, 95% CI 19.53 to 32.53; I² = 0.22%). However, PRP treatment did not significantly improve pregnancy rates compared with controls. Conclusions This meta-analysis suggests that intraovarian PRP may improve ovarian reserve-related markers in women with poor ovarian reserve or ovarian insufficiency/failure, but it does not appear to increase pregnancy rates significantly. These findings should be interpreted cautiously because of the limited number of studies and heterogeneity in treatment protocols, and current evidence remains insufficient to define the optimal PRP regimen or the patient subgroups most likely to benefit. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420251233432 , identifier CRD420251233432.