Ovary laparoscopic incision and intraovarian platelet-rich plasma induce distinct cortical stiffness changes and follicular activation in aged sheep-a pilot study.

PURPOSE: Poor ovarian response and primary ovarian insufficiency remain major challenges in assisted reproductive technologies. Recent advances propose mechanical approaches-such as in vitro activation, drug-free IVA, and whole ovarian laparoscopic incision (WOLI)-as well as biological strategies like platelet-rich plasma (PRP) injections to improve ovarian function. This study aims to evaluate the impact of WOLI and PRP on ovarian follicular activation, with a particular focus on the associated biomechanical alterations in the ovarian cortex.

METHODS

Experimental pilot study includes six aged female Merino sheep. Group A underwent WOLI on one ovary, and group B received PRP injections. Contralateral ovaries served as controls. Laparoscopic bilateral oophorectomies were performed at 2, 4, and 6 months. Atomic force microscopy (AFM) measured ovarian cortical stiffness, and histological analysis assessed follicular activation. Analyses were performed by comparing the operated ovary to the contralateral, non-operated ovary.

RESULTS

AFM measurements showed that in group A, ovarian stiffness significantly increased at 6 months (8.683 kPa vs. 5.551 kPa; p < 0.001), with no significant differences at 2 or 4 months. In group B, stiffness increased significantly at 2 months (11.177 kPa vs. 6.590 kPa; p < 0.001), but not at 4 or 6 months post-intervention. Growing follicle proportions differed between treated and control ovaries respectively, with activation at 2 months (58.95% vs. 29.73%) in group A and 6 months in group B (53.01% vs. 20.33%).

CONCLUSION

The study suggests that the activating effect on ovarian folliculogenesis of both the surgical procedure and PRP administration shows a different time course and that could be related to its effect on ovarian cortex mechanobiology.