Ovarian Rejuvenation for Premature Ovarian Insufficiency and Poor Ovarian Response

Inclusion criteria 1. POI according to ESHRE criteria (patient must fit both criteria): 1. presence of menstrual disturbance defined as oligo/amenorrhea for at least 4 months 2. biochemical confirmation as evidenced by an elevated FSH level \>25 IU/L on two occasions \> 4 weeks apart 2. POR defined by at least two prior cycles with POR (≤3 oocytes retrieved with a conventional stimulation protocol, or a cancelled cycle due to poor response) 3. Patients declining ovum donation treatment Exclusion criteria 1. Age \<18yo or \>38yrs 2. Autoimmune or sex chromosome etiology of POI 3. Ongoing malignancy 4. Previous ovarian surgery 5. Previous gonadotoxic treatment 6. Anticoagulant use for which plasma infusion is contraindicated 7. FMR1 mutations 8. If the duration of the amenorrhea is more than 2 years, patients are discouraged to participate, although it is not an exclusion criterion. 9. Patients with only 1 ovary 10. BMI \> 35 11. Male partner with \<100,000 total motile spermatozoa per ejaculate (donor sperm is acceptable) 12. Surgically obtained sperm 13. Presence of hydrosalpinges that communicate with endometrial cavity 14. Single gene disorder or chromosomal rearrangement requiring a more detailed embryonic genetic analysis 15. Diagnosis of endometrial insufficiency: prior cycle with maximal endometrial thickness ≤ 6mm, abnormal endometrial pattern (failure to attain a trilaminar appearance), persistent endometrial fluid 16. Use of a gestational carrier 17. Any contraindications to undergoing in vitro fertilization or gonadotropin stimulation 18. Known ovaries that are not accessible transvaginally. 19. Ovarian endometrioma(s) or dermoid cyst(s) identified via transvaginal ultrasound 20. FSH \> 40iu/l