Platelet‑rich plasma as an in vitro supplement to human sperm cryopreservation and preparation media: A systematic review

Male infertility affects an estimated 9‑15% of the male population, and both cryopreservation and laboratory sperm preparation can impair sperm function. Platelet‑rich plasma (PRP), a concentrate of platelet‑derived growth factors, has been proposed as a supplement to sperm‑handling media. The present systematic review evaluated whether the in vitro supplementation of human sperm cryopreservation or preparation media with PRP improves sperm quality. For this purpose, the PubMed, the Cochrane Library, ScienceDirect and Google Scholar databases were searched, supplemented by manual searching, for articles published between 2019 and December, 2025. Original studies that added PRP or plasma rich in growth factors to human semen or spermatozoa in vitro and compared the results with an untreated or alternative‑medium control were eligible. Animal studies and studies using in vivo PRP administration were excluded. Risk of bias was assessed with the RoB 2 tool, and the findings were synthesized narratively. Of the 234 records identified, 155 were removed before screening and 30 were excluded on title or abstract screening. Of the 27 full‑text reports assessed, 14 studies (532 human semen samples) were included: Seven on cryopreservation and seven on fresh sperm preparation or incubation. The overall risk of bias was low in four studies, raised some concerns in nine and was high in one study. PRP was associated with higher post‑thaw or post‑preparation motility in the majority of studies and with improved viability, DNA fragmentation and oxidative stress markers in several studies. However, the effects were inconsistent, lower concentrations generally outperformed higher ones, and PRP used alone as a cryoprotectant was detrimental. A meta‑analysis was not performed owing to heterogeneity, and no study reported clinical reproductive or safety outcomes. In summary, limited in vitro evidence suggests that low‑concentration PRP, used as a supplement to standard media, may improve laboratory measures of human sperm quality. Its clinical benefit and safety remain unproven, and standardized PRP preparation and adequately powered studies with reproductive outcomes are required.