Contraception and Reproductive Medicine, 25/09/2025
Introduction
Premature ovarian failure (POF) is the state of menopause before the age of 40, where a women’s ovaries stop functioning as they would normally. It is a serious gynecological condition that leads to a depletion in the ovarian reserve and impairs women’s ability to naturally conceive. POF can be seen as a more severe form of primary ovarian insufficiency (POI); however, both terms are used to describe the same underlying condition of early ovarian dysfunction.
POF is diagnosed through several criteria including most importantly:
- Amenorrhea for at least 4–6 months before the age of 40.
- A high blood level of the follicle-stimulating hormone (FSH) (higher than 40mIU/mL) on at least two blood draws separated by a month, low estradiol levels of less than 30ng/L, and post-menopausal signs (hot flashes, vaginal dryness, night sweats, etc.).
Several conventional treatments are put into place for POF:
- Hormone replacement therapy
- GnRH antagonists
- Pharmacological treatment (coenzyme Q10, resveratrol, melatonin, and rapamycin)
- In vitro fertilization
- Platelet-rich plasma (PRP) therapy
Stem cell therapy in POF
Mesenchymal stem cells (MSCs) are multipotent cells that were initially found mainly in bone marrow and other sources include adipose tissue, bone marrow, dental pulp, mobilized peripheral blood, and umbilical cord.
The mechanisms of action of MSC:
- Migrating to the injured ovarian cell site supports follicular or stromal cells in recovery.
- Their secretome contains bioactive molecules such as insulin-like growth factors and vascular endothelial growth factors.
- Secreted growth factors function in a paracrine manner rather than differentiate into germ cells.
Results of previous studies:
- Restore and maintain ovarian function
- Regenerate damaged endometrium
- Decrease the apoptotic rate of granulosa cells
PRP therapy in POF
PRP refers to the portion of blood containing a high concentration of platelets in plasma, obtained from centrifugation and isolation from red cells and immune cells.
The mechanisms of action of PRP:
- Release of active factors includes cytokines, growth factors, lysosomes, and adhesion proteins to initiate the hemostatic cascade, revascularization, and the synthesis of new connective tissues.
- Release of cell proliferating, differentiation bioactive proteins, hormones, and growth factors responsible for angiogenesis, anabolism, and inflammation control.
Results of previous studies:
- Patients having POF have been able to conceive naturally after PRP administration.
- Menstruation restored and then their hormonal profiles have shown significant improvements.
- Increase in AMH and a decrease in FSH.
Discussion
Advantages
- Generating a complete oogenesis process and other gynecological conditions.
- Restore ovarian function and improve fertility outcomes in women with POF.
- Improve ovarian function and hormone levels.
Disadvantages
- The therapeutic mechanism, dosing, and delivery methods need to be optimized.
- Ensure the safety and efficacy in long-term follow-up studies.
Conclusion
Clinical trials have shown that MSC therapy and PRP therapy are promising treatments for POF. However, further research is needed to confirm its safety and efficacy in humans. In clinical practice, a multidisciplinary approach combining gynecologists, endocrinologists, and reproductive specialists is advised to support comprehensive care for women with POF.
References
Gemayel, J., Harb, F., Karam, F. et al. Mesenchymal stem cells and platelet rich plasma in the treatment of premature ovarian insufficiency: a scoping review. Contracept Reprod Med 10, 57 (2025). https://doi.org/10.1186/s40834-025-00368-1
Source: Contraception and Reproductive Medicine
Link: https://link.springer.com/article/10.1186/s40834-025-00368-1#citeas
