Platelet-rich plasma (PRP), is an autologous blood-derived product rich in growth factors and cytokines. This autologous product has applications in many disciplines, including orthopedics, dermatology, and dentistry, due to its tissue regenerative properties. With the new developments in PRP the treatment modality becomes a potential therapeutic option in reproductive medicine, especially for improving ovarian and oocyte quality (Bos-Mikich et al., 2018). Over the last few years, researchers started exploring PRP's potential use in managing poor ovarian reserve, premature ovarian insufficiency (POI), and poor-quality oocytes, in areas that significantly limit a woman's fertility and are particularly difficult to treat using existing alternatives. Intraovarian PRP therapy is a novel procedure for maximizing ovarian function, particularly among women who present with diminished ovarian responsiveness or poor response to treatments (Atkinson et al., 2021, Parikh et al., 2022).

Can PRP rejuvenate ovarian function and enhance oocyte competence in women with reduced reproductive potential? This important question is at the center of attention for emerging reproductive technologies aimed at reversing age-related infertility and POI.

Limitations of previous studies investigating the effects of PRP on reproduction include small sample sizes, heterogeneity in preparation protocols, and lack of controlled trials and standardization (Wang et al., 2024). Although there have been some reports of improvements in follicle-stimulating hormone (FSH) and anti-Müllerian hormone (AMH), there is not enough data to identify the molecular pathways by which PRP regenerates ovarian tissue. Additionally, the majority of the research that is currently accessible offers anecdotal or hormonal experiences of pregnancy without cellular or mechanistic support. It is unknown what specific bioactive function PRP plays in the transition of follicular activation, oocyte competence, and ovarian microenvironment modulation (Awwad, 2024, Ding et al., 2015).

The novelty of our research resides in its holistic approach that connects basic science to clinical applications. We extend the scope of previous research by determining how PRP impacts granulosa cell gene expression, steroidogenesis, and oocyte mitochondrial integrity, all key factors in embryo development and the potential for pregnancy. Furthermore, we examine the role of PRP as a bio-scaffold for stem cell and exosome-based regenerative approaches in the future and suggest it as a platform technology for the next generation of ovarian rejuvenation treatments. Ultimately, this review aims to refine the conceptual framework of PRP in reproductive medicine by elucidating its mechanistic pathways and clinical implications. As illustrated in Fig. 1, PRP exerts multifactorial effects on ovarian rejuvenation, including activation of intracellular signaling pathways (e.g., PI3K/AKT/mTOR), stimulation of granulosa cell proliferation, and enhancement of angiogenesis and mitochondrial function.