Tree of Life Center continuously seeks to improve pregnancy rates in patients affected by the low ovarian reserve. While ovarian aging is a natural process and an unavoidable process for every maturing female patient, it represents a serious challenge for most fertility treatments. We still encounter many patients seeking fertility treatments late in their reproductive life and some are surprised to find that they are already in peri-menopause. While the ideal solution is to preserve eggs early in life, we understand that egg freezing was not an option that was utilized by many of our patients.
Now, we apparently have a new option - ovarian rejuvenation! Sounds kind of crazy, but platelet-rich plasma can rejuvenate other tissues including bones, heal skin wounds, why not the ovary. Let's look into what it is all about:
Women with ovarian insufficiency have an impaired response to follicle-stimulating hormone and show a low response during ovarian stimulation. The ovary has difficulty maturing follicles and a result is a low number of eggs during fertility therapy. Anti-Mullerian Hormone (AMH) is a great marker of the remaining egg reserve in the ovary. While the egg quality might not directly relate to the AMH levels, it is also affected by age. Follicle-stimulating hormone (FSH) is another marker, however high FSH levels are a dire sign of peri-menopause. Menopausal women might have FSH levels close to 100 mIU/mL. Given that the eggs wait tucked away for many years, the quality deteriorates over time. These eggs, while still capable of producing embryos, results in embryos that do not cleave well and show chromosomal anomalies.
The widely accepted solution for diminished ovarian reserve is egg donation. While providing a quick fix, this option is still not satisfactory for many patients, since it does not allow the passage of own genetic lineage to the offspring.
There has been an intense debate for many years if the ovary is able to develop new eggs from stem cells later in life. The main problem in female reproduction is that eggs are developing from ovarian stem cells only during a short period before birth. Those eggs are supposed to last for the entire female reproductive life. Think about leaving an egg in a fridge for 45 years! The human ovary is better than any fridge, but eggs still get damaged over time.
Tissue regeneration has been studied extensively in wound healing and aesthetics. The rationale is to use own platelets to release growth factors and induce tissue rejuvenation. Recently, data has shown that this might work in the ovary as well. While many sources of growth factors and even growth hormone (GH) have been attempted in the past, we now know that our own platelets contain a lot of growth factors. This is how we repair our blood vessels after injury and heal injured tissues.
Ovarian rejuvenation is an autologous process, meaning that we can use a women's own blood to extract platelet-rich plasma (PRP) inject it back into the ovary. The preparation of PRP is similar to its uses in other tissues, but the injection into the ovary is a delicate process. A small blood sample is obtained and placed into a centrifuge using a special separation device. The platelets are concentrated and activated within the separation tube. An ultrasound-guided thin needle is introduced through the vagina into the ovary. This process is similar to introducing the needle as part of the IVF procedure and as fertility specialists, we are very familiar with this procedure. There is no need for general anesthesia and most patients tolerate this well under local anesthesia and can observe the whole process of ovarian PRP injection while being awake.
At this point, it is not quite clear how ovarian rejuvenation improves ovarian function. It is still debated if the PRP injection into the ovary stimulates new oocyte stem cell development or simply improves the supporting tissues to provide a better environment for the existing oocytes. However, the results in early clinical trials are encouraging and there are reports women experienced improvement with more oocytes available in subsequent treatments. Some women with ovarian failure who already entered menopause started to mature follicles again. Ovarian rejuvenation therapy is particularly interesting for patients who have experienced premature ovarian failure (POF) that might still have a residual ovarian function that can be reactivated. PRP is safe and it has been used for many years and promotes bone and skin healing.
The folliculogenesis and intraovarian stem cells are still not completely understood, however ovarian rejuvenation with PRP might be a novel treatment restoring certain pathways affected by aging and might help patients with infertility due to advanced reproductive age. However, reports suggest that IVF outcomes including the number of oocytes retrieved and the quality of resulting embryos have improved. The ovarian rejuvenation procedure typically takes place about 1-2 months prior to IVF treatment and prepares the patient for a stimulation cycle.
We still have to await the results of clinical trials on how the PRP injection will pass the scientific scrutiny. The rationale behind and early results are promising though and we willing to offer this procedure to our peri-menopausal patients looking for new alternative treatments of diminished ovarian reserve.
Please contact Tree of Life Center in Los Angeles if you desire to find out about this procedure and consult with our fertility specialists about your particular situation. We have special IVF stimulation protocols geared towards maximizing the fertility chances for our patients experiencing diminished ovarian reserve.