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Abstract Study question Could the dysregulation of the inflammatory response in the aged ovary be associated with foamy cells generation and be ameliorated using an alternative therapeutic treatment? Summary answer Aged ovarian macrophages show an inflammatory profile associated with incorporation of lipid droplets that can be reduced after culture with platelet-rich plasma from fertile women. What is known already The concept of ‘inflammaging’ represents the inflammation associated to aging, which is systemic, chronic and linked to the increase of pro-inflammatory mediators. This microenvironment is associated with the presence of ovarian foamy macrophages, a unique subset with intracytoplasmic lipids accumulation. Here, we investigate the mechanisms underlying the exacerbated inflammatory response during ovarian aging, focusig on the generation of foamy macrophages and their impact in oocyte quality. Since, oocytes develop in the context of ovarian follicles, we obtained follicular fluid (FF) from women with different ages, to investigate ovarian immune microenvironment and their modulation after in vitro platelet-rich plasma (PRP) treatment. Study design, size, duration Mononuclear cells were recovered from FF from women of different ages and IL-1β production and macrophages and lymphocytes profiles tested by immune-staining and FACS analysis. To test foamy cells generation, we measured surface and intracellular CD68 expression (scavenger receptor involved in lipid accumulation). Immune cells profiles were correlated with clinic parameters as number of oocytes, M2 and atretic follicles. Finally, isolated ovarian macrophages were treated with PRP and modulation of macrophage profile was tested. Participants/materials, setting, methods We studied FF (n = 70) from women from ovodonation (21-29y), with cryopreservation desire (30-35y) and ART indication (36-42y). The San Isidro Ethics Committee, Buenos Aires, Argentina, approved this study. Mononuclear cells were isolated using Ficoll-Hypaque and macrophages profile (IL-1β+, CD68+) and the novel lymphocyte regulatory subpopulation (CD3+CD4-CD8-) tested by flow cytometry. Lipid droplets were measured using BODIPY 493/503 probe. Ovarian macrophages were isolated by adherence and treated with PRP (obtained from fertile women) for 5 days. Main results and the role of chance FF macrophages from aged women (35-42y) showed a significant increase in IL-1β production in comparison with the youngest group (21-29y), that also correlates negatively with the number of M2 oocytes recovered. Focusing on macrophage characterization, FF from aged women displayed an increased frequency of CD68+ macrophages in comparison with young women. Since CD68 shuttles between the cytoplasm and the plasmatic membrane to incorporate lipids, we evaluated lipid accumulation in FF macrophages to generate foamy cells. Interestingly, we found an increase of lipid droplets in FF macrophages from aged women in comparison with the younger group. Therefore, we discriminated surface and intracellular CD68 detection and found higher intracellular CD68 expression in aged macrophages, correlating with lipid droplets accumulation. Then, we isolated ovarian macrophages from aged women and treated with fertile PRP to evaluate its modulatory effects and observed a reduction in the frequency of CD68+IL-1β cells in comparison with those cultures without treatment. Finally, we focused on a novel T lymphocyte regulatory subpopulation, CD3+CD4-CD8- (DNT), that is emerging as effector cells capable of mediating immune tolerance in the female reproductive system. We found that FF from aged women displayed a reduced frequency of DNT, in comparison with FF from younger women. Limitations, reasons for caution The present results were obtained using FF samples from women from different ages. Even though the samples represent the ovarian microenvironment, it is difficult to study the human ovary per se and further studies are necessary to elucidate whether these mechanisms operate similarly in vivo. Wider implications of the findings We demonstrated that dysregulation of the inflammatory response during aging leads to the generation of foamy cells and reduction of DNT cells associated to the regulation of the immune ovarian microenvironment impacting in oocyte quality. In vitro PRP treatment displayed immunomodulatory effects, suggesting its relevance as a potential therapeutic treatment. Trial registration number not applicable