In endometrial rejuvenation, the target organ is the endometrium — the inner lining of the uterus. This is done in cases of recurrent implantation failure. We don’t do it on the standard IVF patient, or what you might call the “easy” IVF patient. We do it on patients who have a history of miscarriages, recurrent implantation failure, a history of surgery involving the endometrium, or in cases where we see a thin or abnormal endometrium.
“Thin” is one type of assessment. There are others as well, such as the size and shape of the endometrium, and Doppler studies are used to assess endometrial blood flow and pulsatility. Endometrial PRP is directed at the endometrium.
Ovarian PRP is directed at the ovaries. The reason you would do ovarian PRP is to improve ovarian response. A very popular term — although I don’t particularly like it — is “rejuvenation.” The idea is that PRP may help the failing ovaries grow more follicles or improve egg quality. That’s the main difference.
In terms of technique, for endometrial PRP, we place the PRP component inside the uterus. For ovarian PRP, we inject the PRP solution directly into the ovary. So, it’s a different target and a different organ. For ovarian PRP, we have two approaches. Although ovarian PRP is targeted to the ovaries, this can be done either: Vaginally (just like during egg collection, under ultrasound guidance), or through laparoscopy.
How we choose the route depends on access to the ovaries. Sometimes, the ovaries are small, atrophic, and do not produce many or any eggs. Maybe they’ve been operated on before, or affected by endometriosis, making them inaccessible vaginally. In that case, we choose laparoscopy.
I also suggest laparoscopy even when the ovaries are accessible vaginally — especially in cases of unexplained infertility. In my experience, in those patients, I have a 50% chance of identifying endometriosis. So, we “kill three or four birds with one stone”:
A little bonus, and this is very important because I always like to focus on the positive, is that even endometrial PRP may benefit ovarian rejuvenation in women undergoing IVF with their own eggs, provided that the tubes are open. Why? Because we flush the PRP through the tubes, it reaches the ovaries.
In our own series — we’ve been performing this for about 16 months — we found, quite miraculously, that women who received endometrial PRP showed improvement in ovarian response as well.
There are different types of rejuvenation. If we are talking about PRP, the method is to take blood, own blood, prepare this blood in a specific way, necessary centrifugate several times, take these activated lymphocytes and inject them inside of the ovary. We have done this procedure several times and in some cases, it improved after two-three months. In some cases, sincerely speaking I don’t see a lot of results. It is difficult to say in which case it will be really helpful.
We are doing that for thin endometrium: we inject these cells inside of the uterus during the preparation for the embryo transfer and sometimes it improves endometrium but in some patients there is no reaction (no improvement). There is another method of rejuvenation: we take some part of ovarian tissue, then do specific preparation to activate factors that normally regulate the transformation from preantral follicles in small antral, etc., then, we put it back. This method, according to the literature, gives better results. In Ukraine, we still did not try to do that. One clinic reported that tried to do it but not enough information if it is maybe very very helpful. Some authors say that it is a good and interesting method.
Just talking about it seems that there are two methods one: using activated lymphocytes after specific preparation, we inject them in the ovary and this is PRP therapy. It may be helpful. Some publications say that it is very very helpful. From my own experience, yes, in some cases it may be helpful but not in all cases work well. Another method is activating ovarian tissue with specific factors which normally regulate follicle recruitment and follicular atresia and this is the main difference
