The pace of intraovarian platelet-rich plasma (PRP) research has increased since the revolutionary work by Pantos et al. in 2016 [1]. Their study was the first to describe a novel PRP application, outlining how a non-pharmacologic method can ameliorate the consequences of ovarian senescence. While hormone replacement therapy (HRT) for menopause and advanced reproductive technologies/in vitro fertilization (IVF) for infertility are well established and familiar [2], the exploration of workable alternatives is important. Successful return of menses after menopause (as a substitute for HRT) and healthy term live births for infertility patients (either with IVF or as unassisted conceptions) following intraovarian PRP have placed this procedure under intense scrutiny, as expected. While intraovarian PRP research remains developmental and nonuniform, a related challenge exists concerning how reports discussing this experimental treatment enter the literature. Against this background, our analysis addressed these open questions: (1) how have basic science research and experience with intraovarian PRP evolved in recent years, (2) what publishing options are most commonly used by those working in this specific arena, and (3) are there features of the literature that can better meet the needs of the medical authorship community?

The standard Medical Subject Heading terms “ovarian” AND “platelet rich plasma” were used to conduct a Boolean search on the U.S. NLM PubMed platform to retrieve publications for analysis. Manuscripts accessed with the following terms/key words were also queried: “ovarian,” “ovary,” “PRP,” “platelet rich plasma,” and “rejuvenation.” All results were compared (Supplementary Material 1) and the current analysis was performed on the search that returned the largest set (n=54). Papers were removed if the subject was outside the scope of reproductive biology (n=12). Next, the following information was recorded from all remaining abstracts: manuscript type (original data vs. review), veterinary versus human research, sample size, patient age data, the inclusion of a placebo group, the total number of listed authors, the nationality of the first author’s institution, and the availability of free full-text access to the publication. The interval between manuscript submission and publication was also computed from the date information for each article, if given. Article processing charges (APCs) were determined from journal homepages. Information on current clinical study activity in the “ovarian rejuvenation” space was collected from the U.S. NIH Clinical Trials internet portal (www.clinicaltrials.gov) where a similar audit was undertaken. No identifiable patient-level data were included for analysis in this study.

As with any new medical application, the activity of early adopters is often balanced by appropriate mainstream skepticism. This study is the first to describe publishing patterns and measure aggregate output trends on intraovarian PRP from these “lighthouse” researchers. Here a global snapshot of research is provided, both human and veterinary, with documentation of where the research originates, who publishes it, how long it takes to become available, and other aspects. Based on the present findings, the distribution of literature among original clinical work, experimental/animal model activity, and commentary or opinion contributions seems relatively even. Most intraovarian PRP research originates from a handful of countries for now, but the full roster of experts covering this topic actually shows a wider source of global productivity. This shared international interest is also apparent on the U.S. NIH clinical trials registry, although this compilation underscores the need for more projects on ovarian rejuvenation.

Several factors identified here might help improve the current situation. Authors of descriptive studies or case reports on intraovarian PRP should include key data in the abstract content, so readers can identify specific facts regarding the population and technique when accessing the abstracts via PubMed. A checklist is now available to meet this need, and adherence to this standard will help clarify future reporting on intraovarian PRP [3]. Academic publishers also have an assignment—they should revisit their toll-collection tendencies and release full texts after 12–18 months into the public domain without charge. The commercial interface between physician-scientists and venues (journals) to disseminate their work will remain relevant given the fast-rising oligopoly of scholarly publishing [4].

As a conspectus of published scholarship on an emerging topic, this analysis has some weaknesses. Unregistered or unpublished activity on intraovarian PRP certainly exists, so the role of publication bias against negative results must be acknowledged. The U.S. NIH Clinical Trials registry also may not give an accurate forecast of research in process, and not all clinical trials are focusing exclusively on PRP. Curiously, no information is available to explain why the status for half of these investigations is either paused or unknown. Furthermore, if the current APCs are not the same as they were when a manuscript was published, this difference would escape detection using this study design. While it is encouraging that each full year’s data reveal progress with increasing activity, further monitoring will be needed to show if this trend continues.

It should be noted that even when a robust, proper RCT for intraovarian PRP does become available, mainstream clinical practice patterns might still resist meaningful change. For example, bias against intrauterine insemination and in favor of IVF as being universally superior has been spotlighted as unfounded, inappropriate, and deserving reappraisal [5]. Thus physician training, background, or experience can sometimes outweigh the persuasive gravitas of the RCT. Indeed, this laudable goal is missed by fertility subspecialists who have already admitted much into the clinical arena without RCT support. Perhaps the most conspicuous examples are IVF and intracytoplasmic sperm injection [6,7], both of which became accepted therapeutic mainstays with no RCT validation. Nonetheless, a focus on intraovarian PRP could help enlarge the therapeutic arsenal for women’s health safely, ideally with RCT data. Our analysis suggests this is already underway at numerous research units.