Platelet-Rich Plasma in Sperm Processing for Assisted Reproductive Technology: Molecular Mechanisms, Clinical Applications, and Future Directions

Male infertility contributes to nearly half of infertile couples, with asthenozoospermia and oligoasthenoteratozoospermia as predominant factors. Despite advancements in sperm processing techniques, the outcomes remain limited in severe cases, particularly concerning motility, mitochondrial function, and DNA integrity. Platelet-rich plasma (PRP), an autologous concentrate rich in platelets (>1 × 106/μL) and growth factors, has recently gained attention as an adjunctive therapy in andrology and assisted reproduction. This review systematically evaluated studies published between 2015 and 2025 investigating PRP use in sperm processing, including in vitro experiments, clinical trials, animal models, and mechanistic studies. PRP demonstrated concentration-dependent benefits, with 5% PRP yielding optimal improvements: motility increased by 15-30%, mitochondrial activity increased by up to 80% (p = 0.002), and oxidative stress was significantly reduced (p < 0.001). PRP's effects on DNA integrity differ by application

intratesticular administration improves spermatogenesis, producing sperm with reduced DNA fragmentation (~33% relative reduction after 3 months, p < 0.001), while in vitro supplementation provides limited protection against processing-induced damage. Mechanisms involve antioxidant action, mitochondrial protection via AMP-activated protein kinaseNuclear Factor kappa-light-chain-enhancer of activated B cells (AMPK/NF-κB) modulation, membrane stabilization, and the selective preservation of higher-quality spermatozoa. PRP shows consistent biological efficacy and safety but lacks methodological standardization. Fewer than 20% of studies report platelet concentrations, limiting reproducibility. Standardized protocols distinguishing leukocyte-poor from leukocyte-rich preparations and randomized trials focusing on live birth rates are recommended. This review proposes an eight-point characterization checklist for future research.