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Moustakli E, Potiris A, Zikopoulos A, Zachariou A, Topis S, Panagopoulos P, Domali E, Drakakis P, Stavros S. Platelet-Rich Plasma (PRP) in Reproductive Medicine: A Critical Review of PRP Therapy in Low-Reserve and Premature Ovarian Insufficiency. Biomedicines 2025; 13:1257. [PMID: 40427083 PMCID: PMC12109040 DOI: 10.3390/biomedicines13051257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2025] [Revised: 05/17/2025] [Accepted: 05/19/2025] [Indexed: 05/29/2025] Open
Abstract
Background: Intraovarian platelet-rich plasma (PRP) has emerged as a novel intervention at the intersection of reproductive medicine and regenerative biology. As women with diminished ovarian reserve (DOR), poor response to stimulation, or premature ovarian insufficiency (POI) seek fertility solutions, PRP provides a scientifically plausible-yet exploratory-strategy to restore or augment ovarian function. The proposed pathways include the stimulation of local stem cells, tissue remodeling, neoangiogenesis, and the potential reawakening of dormant follicles. Methods: This narrative review critically synthesizes the existing literature on intraovarian PRP therapy. It draws from published case series, pilot studies, and preclinical data to evaluate the biological rationale, clinical outcomes, and current limitations of PRP use in women with DOR and POI. Results: Early clinical findings, albeit limited to modest case series and pilot investigations, reveal promising outcomes such as improved ovarian reserve markers, menstrual restoration, and infrequent spontaneous pregnancies in women who had previously been unresponsive to treatment. However, the variability in preparation techniques, patient selection criteria, and outcome measures limits the generalizability of these results. Conclusions: While intraovarian PRP presents an exciting frontier in reproductive medicine, the absence of defined protocols, controlled trials, and long-term safety data underscores its experimental nature. Future research should focus on standardizing methodologies, conducting randomized controlled trials, and elucidating the molecular mechanisms underlying observed clinical effects to establish PRP's role in managing poor ovarian response and POI.
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Affiliation(s)
- Efthalia Moustakli
- Laboratory of Medical Genetics, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece;
| | - Anastasios Potiris
- Third Department of Obstetrics and Gynecology, University General Hospital “ATTIKON”, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.P.); (A.Z.); (S.T.); (P.P.); (P.D.)
| | - Athanasios Zikopoulos
- Third Department of Obstetrics and Gynecology, University General Hospital “ATTIKON”, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.P.); (A.Z.); (S.T.); (P.P.); (P.D.)
| | - Athanasios Zachariou
- Department of Urology, School of Medicine, Ioannina University, 45110 Ioannina, Greece;
| | - Spyridon Topis
- Third Department of Obstetrics and Gynecology, University General Hospital “ATTIKON”, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.P.); (A.Z.); (S.T.); (P.P.); (P.D.)
| | - Periklis Panagopoulos
- Third Department of Obstetrics and Gynecology, University General Hospital “ATTIKON”, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.P.); (A.Z.); (S.T.); (P.P.); (P.D.)
| | - Ekaterini Domali
- First Department of Obstetrics and Gynecology, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece;
| | - Peter Drakakis
- Third Department of Obstetrics and Gynecology, University General Hospital “ATTIKON”, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.P.); (A.Z.); (S.T.); (P.P.); (P.D.)
| | - Sofoklis Stavros
- Third Department of Obstetrics and Gynecology, University General Hospital “ATTIKON”, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.P.); (A.Z.); (S.T.); (P.P.); (P.D.)
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Potiris A, Moustakli E, Trismpioti E, Drakaki E, Mavrogianni D, Matsas A, Zikopoulos A, Sfakianakis A, Tsakiridis I, Dagklis T, Zachariou A, Christopoulos P, Domali E, Drakakis P, Stavros S. From Inflammation to Infertility: How Oxidative Stress and Infections Disrupt Male Reproductive Health. Metabolites 2025; 15:267. [PMID: 40278397 PMCID: PMC12029481 DOI: 10.3390/metabo15040267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2025] [Revised: 04/01/2025] [Accepted: 04/10/2025] [Indexed: 04/26/2025] Open
Abstract
BACKGROUND/OBJECTIVES Inflammation, infections, and oxidative stress (OS) all have an impact on male infertility, which is a complicated, multifaceted illness. OS affects motility and fertilization capability. It accomplishes this through damaging sperm DNA, oxidizing proteins, and triggering lipid peroxidation. These effects occur due to an imbalance between reactive oxygen species (ROS) and antioxidant defenses. METHODS This review aims to evaluate the impact of oxidative stress and inflammation on male infertility by assessing recent literature. RESULTS Pro-inflammatory cytokines, like TNF-α and IL-6, interfere with spermatogenesis and promote oxidative damage. Additionally, infections caused by pathogens like Escherichia coli and Chlamydia trachomatis alter the reproductive microenvironment, leading to sperm dysfunction and inflammation. CONCLUSIONS Early detection and targeted treatment are essential due to the intricate interactions among these elements. Microbiota-modulating techniques, antimicrobial therapies, anti-inflammatory drugs, and antioxidants are therapeutic approaches that may help reduce oxidative damage and enhance male fertility.
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Affiliation(s)
- Anastasios Potiris
- Third Department of Obstetrics and Gynecology, University General Hospital “ATTIKON”, Medical School, National and Kapodistrian University of Athens, 124 62 Athens, Greece; (A.Z.); (P.D.)
| | - Efthalia Moustakli
- Laboratory of Medical Genetics, Faculty of Medicine, School of Health Sciences, University of Ioannina, 451 10 Ioannina, Greece;
| | - Eleni Trismpioti
- First Department of Obstetrics and Gynecology, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, 115 28 Athens, Greece; (E.T.); (E.D.); (D.M.); (E.D.)
| | - Eirini Drakaki
- First Department of Obstetrics and Gynecology, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, 115 28 Athens, Greece; (E.T.); (E.D.); (D.M.); (E.D.)
| | - Despoina Mavrogianni
- First Department of Obstetrics and Gynecology, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, 115 28 Athens, Greece; (E.T.); (E.D.); (D.M.); (E.D.)
| | - Alkis Matsas
- Laboratory of Experimental Surgery and Surgical Research “N.S. Christeas”, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece;
| | - Athanasios Zikopoulos
- Third Department of Obstetrics and Gynecology, University General Hospital “ATTIKON”, Medical School, National and Kapodistrian University of Athens, 124 62 Athens, Greece; (A.Z.); (P.D.)
| | - Antonios Sfakianakis
- Homerton Fertility Centre, Homerton University Hospital, Homerton Row, Clapton, London E9 6SR, UK;
| | - Ioannis Tsakiridis
- Third Department of Obstetrics and Gynecology, General Hospital Ippokratio, Medical School, Aristotle University of Thessaloniki, 546 42 Thessaloniki, Greece; (I.T.); (T.D.)
| | - Themistoklis Dagklis
- Third Department of Obstetrics and Gynecology, General Hospital Ippokratio, Medical School, Aristotle University of Thessaloniki, 546 42 Thessaloniki, Greece; (I.T.); (T.D.)
| | - Athanasios Zachariou
- Department of Urology, School of Medicine, Ioannina University, 45110 Ioannina, Greece;
| | - Panagiotis Christopoulos
- Second Department of Obstetrics and Gynecology, Aretaieion University Hospital, Medical School, National and Kapodistrian University of Athens, 115 28 Athens, Greece
| | - Ekaterini Domali
- First Department of Obstetrics and Gynecology, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, 115 28 Athens, Greece; (E.T.); (E.D.); (D.M.); (E.D.)
| | - Peter Drakakis
- Third Department of Obstetrics and Gynecology, University General Hospital “ATTIKON”, Medical School, National and Kapodistrian University of Athens, 124 62 Athens, Greece; (A.Z.); (P.D.)
| | - Sofoklis Stavros
- Third Department of Obstetrics and Gynecology, University General Hospital “ATTIKON”, Medical School, National and Kapodistrian University of Athens, 124 62 Athens, Greece; (A.Z.); (P.D.)
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Drakaki E, Stavros S, Dedousi D, Potiris A, Mavrogianni D, Zikopoulos A, Moustakli E, Skentou C, Thomakos N, Rodolakis A, Drakakis P, Domali E. The Effect of Bisphenol and Its Cytotoxicity on Female Infertility and Pregnancy Outcomes: A Narrative Review. J Clin Med 2024; 13:7568. [PMID: 39768492 PMCID: PMC11728370 DOI: 10.3390/jcm13247568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2024] [Revised: 11/29/2024] [Accepted: 12/10/2024] [Indexed: 01/03/2025] Open
Abstract
Bisphenols, particularly bisphenol A (BPA), are among the most thoroughly investigated endocrine disrupting chemicals (EDCs). BPA was the first synthetic estrogen to be identified, exerting its estrogenic effects through interaction with human estrogen receptors (ERs). The aim of the present narrative review is to summarize the most recent literature regarding the adverse effects of bisphenols on female fertility and pregnancy outcomes. A review of the literature in the PubMed/Medline and Scopus databases was conducted in November 2024 and 15 studies were included in the present review. BPA levels were higher in women with diminished ovarian reserve, polycystic ovary syndrome, and recurrent miscarriages. Furthermore, one study showed a significant association between BPA levels and the onset of gestational diabetes mellitus. Higher levels of BPA are associated with disruptions to the female reproductive system, such as ovarian function, reduced number of antral follicles, and lower anti-Müllerian hormone (AMH) levels. Bisphenols A and S were associated with an increased risk of developing gestational diabetes mellitus. Bisphenols A and F were correlated with an increased risk of lower birth weight and bisphenol F seemed to be associated with an increased risk of preterm delivery. Ultimately, further research is necessary to fully understand the extent of the harmful effects that bisphenols have separately and as mixtures on the female reproductive system.
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Affiliation(s)
- Eirini Drakaki
- First Department of Obstetrics and Gynecology, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, 115 28 Athens, Greece; (E.D.); (D.D.); (D.M.); (N.T.); (A.R.); (E.D.)
| | - Sofoklis Stavros
- Third Department of Obstetrics and Gynecology, University General Hospital “ATTIKON”, Medical School, National and Kapodistrian University of Athens, 124 62 Athens, Greece; (S.S.); (A.Z.); (P.D.)
| | - Dimitra Dedousi
- First Department of Obstetrics and Gynecology, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, 115 28 Athens, Greece; (E.D.); (D.D.); (D.M.); (N.T.); (A.R.); (E.D.)
| | - Anastasios Potiris
- Third Department of Obstetrics and Gynecology, University General Hospital “ATTIKON”, Medical School, National and Kapodistrian University of Athens, 124 62 Athens, Greece; (S.S.); (A.Z.); (P.D.)
| | - Despoina Mavrogianni
- First Department of Obstetrics and Gynecology, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, 115 28 Athens, Greece; (E.D.); (D.D.); (D.M.); (N.T.); (A.R.); (E.D.)
| | - Athanasios Zikopoulos
- Third Department of Obstetrics and Gynecology, University General Hospital “ATTIKON”, Medical School, National and Kapodistrian University of Athens, 124 62 Athens, Greece; (S.S.); (A.Z.); (P.D.)
| | - Efthalia Moustakli
- Laboratory of Medical Genetics, Faculty of Medicine, School of Health Sciences, University of Ioannina, 451 10 Ioannina, Greece;
| | - Charikleia Skentou
- Department of Obstetrics and Gynecology, Medical School, University of Ioannina, 451 10 Ioannina, Greece;
| | - Nikolaos Thomakos
- First Department of Obstetrics and Gynecology, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, 115 28 Athens, Greece; (E.D.); (D.D.); (D.M.); (N.T.); (A.R.); (E.D.)
| | - Alexandros Rodolakis
- First Department of Obstetrics and Gynecology, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, 115 28 Athens, Greece; (E.D.); (D.D.); (D.M.); (N.T.); (A.R.); (E.D.)
| | - Peter Drakakis
- Third Department of Obstetrics and Gynecology, University General Hospital “ATTIKON”, Medical School, National and Kapodistrian University of Athens, 124 62 Athens, Greece; (S.S.); (A.Z.); (P.D.)
| | - Ekaterini Domali
- First Department of Obstetrics and Gynecology, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, 115 28 Athens, Greece; (E.D.); (D.D.); (D.M.); (N.T.); (A.R.); (E.D.)
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Stavros S, Potiris A, Christopoulos P, Zacharopoulou N, Kyrli V, Mavrogianni D, Zikopoulos A, Drakaki E, Karampitsakos T, Topis S, Machairiotis N, Gerede A, Skentou C, Drakakis P, Domali E. Association of the miR-143 Gene rs353292 Polymorphism with Recurrent Pregnancy Loss in Caucasian Women: A Novel Finding in a Multifactorial Devastating Problem. Int J Mol Sci 2024; 25:11952. [PMID: 39596022 PMCID: PMC11593960 DOI: 10.3390/ijms252211952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2024] [Revised: 11/05/2024] [Accepted: 11/06/2024] [Indexed: 11/28/2024] Open
Abstract
The purpose of this prospective case-control study is to investigate the correlation of the miR-143 gene rs353292 polymorphism in Caucasian women with recurrent pregnancy loss (RPL) compared to a matched control group with at least one live birth and without pregnancy losses. In total, 110 women with recurrent pregnancy losses and 95 control women were recruited. Peripheral blood was collected from all women, and the isolation of DNA was performed with Monarch Genomic DNA Purification. Polymerase chain reaction was applied to amplify the DNA sequence of the miR-143 gene promoter, carrying the polymorphism rs353292. The incidence of genotype CC in the RPL group was statistically significantly higher than in control group (p < 0.0001). Allele C (CT + CC) in the control group was found in 47.36%, and in the RPL group was found in 68.17% (p = 0.006). SNP rs353292 T>C was associated with increased risk of recurrent pregnancy loss. The calculated odds ratio for CT + CC vs. TT and for CC vs. TT were significant higher (p = 0.0028 and p < 0.0001, respectively). The study results suggest that the rs353292 polymorphism is associated with a statistically significant increase in RPL prevalence. The present study provides additional evidence in favor of a shared pathophysiological mechanism that contributes to both RPLs, potentially through inflammatory processes and epithelial-mesenchymal transition dysregulation.
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Affiliation(s)
- Sofoklis Stavros
- Third Department of Obstetrics and Gynecology, University General Hospital “ATTIKON”, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (S.S.); (A.Z.); (T.K.); (S.T.); (N.M.); (P.D.)
| | - Anastasios Potiris
- Third Department of Obstetrics and Gynecology, University General Hospital “ATTIKON”, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (S.S.); (A.Z.); (T.K.); (S.T.); (N.M.); (P.D.)
| | - Panagiotis Christopoulos
- Second Department of Obstetrics and Gynecology, Aretaieion University Hospital, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece;
| | - Natalia Zacharopoulou
- First Department of Obstetrics and Gynecology, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece; (N.Z.); (V.K.); (D.M.); (E.D.); (E.D.)
| | - Vasiliki Kyrli
- First Department of Obstetrics and Gynecology, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece; (N.Z.); (V.K.); (D.M.); (E.D.); (E.D.)
| | - Despoina Mavrogianni
- First Department of Obstetrics and Gynecology, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece; (N.Z.); (V.K.); (D.M.); (E.D.); (E.D.)
| | - Athanasios Zikopoulos
- Third Department of Obstetrics and Gynecology, University General Hospital “ATTIKON”, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (S.S.); (A.Z.); (T.K.); (S.T.); (N.M.); (P.D.)
| | - Eirini Drakaki
- First Department of Obstetrics and Gynecology, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece; (N.Z.); (V.K.); (D.M.); (E.D.); (E.D.)
| | - Theodoros Karampitsakos
- Third Department of Obstetrics and Gynecology, University General Hospital “ATTIKON”, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (S.S.); (A.Z.); (T.K.); (S.T.); (N.M.); (P.D.)
| | - Spyridon Topis
- Third Department of Obstetrics and Gynecology, University General Hospital “ATTIKON”, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (S.S.); (A.Z.); (T.K.); (S.T.); (N.M.); (P.D.)
| | - Nikolaos Machairiotis
- Third Department of Obstetrics and Gynecology, University General Hospital “ATTIKON”, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (S.S.); (A.Z.); (T.K.); (S.T.); (N.M.); (P.D.)
| | - Angeliki Gerede
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 69100 Campus, Greece;
| | - Chara Skentou
- Department of Obstetrics and Gynecology, Medical School, University of Ioannina, 45110 Ioannina, Greece;
| | - Peter Drakakis
- Third Department of Obstetrics and Gynecology, University General Hospital “ATTIKON”, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (S.S.); (A.Z.); (T.K.); (S.T.); (N.M.); (P.D.)
| | - Ekaterini Domali
- First Department of Obstetrics and Gynecology, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece; (N.Z.); (V.K.); (D.M.); (E.D.); (E.D.)
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Dedousi D, Potiris A, Zikopoulos A, Karampitsakos T, Topis S, Skentou C, Gerede A, Christopoulos P, Zachariou A, Domali E, Drakakis P, Stavros S. The Impact of Human Papillomavirus Infections on Recurrent Pregnancy Loss: A Review of the Literature. Diseases 2024; 12:214. [PMID: 39329883 PMCID: PMC11431260 DOI: 10.3390/diseases12090214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Revised: 09/12/2024] [Accepted: 09/12/2024] [Indexed: 09/28/2024] Open
Abstract
Human papillomavirus (HPV) infections are significantly associated with multiple adverse reproductive outcomes such as miscarriages. Pregnant women are more susceptible to an HPV infection and its prevalence increases as pregnancy progresses. In this present review, we summarize the existing evidence indicating the potential impact of an HPV infection on the occurrence of recurrent pregnancy loss (RPL). Comprehensive research of the literature was performed in the Medline/PubMed and Scopus databases. A total of 185 articles were identified and 40 full-text articles were assessed. Four studies were eligible to be included in this literature review. To our knowledge, this is the first review aiming to summarize the current state of evidence regarding the possible association of HPV infections and RPL. Recurrent pregnancy loss constitutes a distressing reproductive event and scientific research has made significant efforts to determine the causes and mechanisms that could lead to RPL. It is still unclear whether the papillomavirus infection is associated with an increased risk for recurrent miscarriages. Research in the field revealed conflicting results and their deductions are limited by methodological limitations. Given the high prevalence of HPV infections and their potential role in the occurrence of adverse outcomes during pregnancy, further research is required to clarify the possibility of an HPV infection being a potential risk factor for recurrent miscarriages.
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Affiliation(s)
- Dimitra Dedousi
- First Department of Obstetrics and Gynecology, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, 115 28 Athens, Greece; (D.D.); (E.D.)
| | - Anastasios Potiris
- Third Department of Obstetrics and Gynecology, University General Hospital “ATTIKON”, Medical School, National and Kapodistrian University of Athens, 124 62 Athens, Greece; (A.Z.); (T.K.); (S.T.); (P.D.); (S.S.)
| | - Athanasios Zikopoulos
- Third Department of Obstetrics and Gynecology, University General Hospital “ATTIKON”, Medical School, National and Kapodistrian University of Athens, 124 62 Athens, Greece; (A.Z.); (T.K.); (S.T.); (P.D.); (S.S.)
| | - Theodoros Karampitsakos
- Third Department of Obstetrics and Gynecology, University General Hospital “ATTIKON”, Medical School, National and Kapodistrian University of Athens, 124 62 Athens, Greece; (A.Z.); (T.K.); (S.T.); (P.D.); (S.S.)
| | - Spyridon Topis
- Third Department of Obstetrics and Gynecology, University General Hospital “ATTIKON”, Medical School, National and Kapodistrian University of Athens, 124 62 Athens, Greece; (A.Z.); (T.K.); (S.T.); (P.D.); (S.S.)
| | - Charikleia Skentou
- Department of Obstetrics and Gynecology, Medical School, University of Ioannina, 451 10 Ioannina, Greece;
| | - Angeliki Gerede
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 691 00 Campus, Greece;
| | - Panagiotis Christopoulos
- Second Department of Obstetrics and Gynecology, Aretaieion University Hospital, Medical School, National and Kapodistrian University of Athens, 115 28 Athens, Greece;
| | - Athanasios Zachariou
- Department of Urology, School of Medicine, Ioannina University, 451 10 Ioannina, Greece;
| | - Ekaterini Domali
- First Department of Obstetrics and Gynecology, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, 115 28 Athens, Greece; (D.D.); (E.D.)
| | - Peter Drakakis
- Third Department of Obstetrics and Gynecology, University General Hospital “ATTIKON”, Medical School, National and Kapodistrian University of Athens, 124 62 Athens, Greece; (A.Z.); (T.K.); (S.T.); (P.D.); (S.S.)
| | - Sofoklis Stavros
- Third Department of Obstetrics and Gynecology, University General Hospital “ATTIKON”, Medical School, National and Kapodistrian University of Athens, 124 62 Athens, Greece; (A.Z.); (T.K.); (S.T.); (P.D.); (S.S.)
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