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How ovarian rejuvenation and PRP may work for patients with diminished ovarian reserve?

ovarian-rejuvenation-webinar
From this video you will find out:
  • What diminished ovarian reserve mean?
  • What is PRGF (Plasma rich in growth factors) and how does it work?
  • What are the indications for PRGF treatment?
  • What are the contraindications for PRGF treatment?

How ovarian rejuvenation and PRP may work for patients with diminished ovarian reserve?

Are PRP and growth factors indicated for patients with low ovarian reserve?

During this event, Dr Daniel Bodri, Gynaecologist & Fertility Specialist at IVF-Life, discussed PRP and ovarian rejuvenation and whether patients with diminished ovarian reserve can also benefit from such procedures.

Are PRP and growth factors indicated for patients with low ovarian reserve? - Questions and Answers

I’m 38 and starting IVF. Despite a full protocol and then reverting to mini or mild IVF, it had the same outcome. The follicles were empty, and only 1 egg was retrieved. I am healthy, I have no medical history of illness and I have a healthy weight. What would you advise me? My progesterone is 28 nmol/L consistent with ovulation, and my FSH is 7.6.

These are normal values, and the fact that 1 egg was retrieved is a sort of positive thing. I would recommend trying to do other stimulations, actually many mild IVF or mini IVF stimulations. I had the opportunity to work in Japan, they only do mini IVF, and the drawback of this approach is that many of the collections or embryo transfers don’t arrive until the end, so it has a sort of low efficiency. The question is, what other protocols could you try? We could analyse it if you send us some more information, but definitely, I think you would be a good candidate to do the ovarian PRP treatment, and the idea would probably be doing several stimulations, even if it’s a few eggs, then potentially trying to create blastocysts.

Is there any age limit for PRP treatment?

We have the same limit, which is 50 for the treatment in Spain, even across the clinics, it’s quite consistent, so up until 50, you would probably be treated. Although it’s true that with own eggs after 45, the results are very low. In some publications where patients underwent PRP treatment, it has been shown that, in some cases, there are spontaneous pregnancies. It’s not a stretch if somebody goes for PRP treatment between 45 and 50 and tries to do some treatments, ovulation induction, etc. there could be some positive response to the PRP treatment. There could be at least a PRP trial, and we would see if it’s improved some of these ovarian reserve markers, and then the results.

Why are a lot of gynaecologists reluctant about PRP or ovarian rejuvenation?

It’s a new thing that appeared a few years ago, depending on the country. Many of these publications come from Greece or some countries like Iran, South America, and Turkey, most of them don’t come from European countries, some studies are already registered on a website, but some of these studies need to be sort of registered, so there is some activity going on but not all the clinics have the innovative spirit to launch it. More and more clinics in Spain are starting to do it, that’s for sure.

As the product comes from the patient, how does removing it, and separating the blood from the platelet-rich plasma help?

It’s because it is sort of concentrated, so even if the blood has platelets and there are growth factors in the platelets, these platelets are concentrated, and activated, so, in the end, we would have like a plasma which is full of growth factors. I mean, in normal circumstances, you would not have such a high concentration whether you use it in a knee joint or if you introduce it to stimulate the growth of hair growth, of course, I don’t have any experience with these treatments, but if you introduce it in the uterine cavity and the lining, which is changing all the time and is under the influence of some of these growth factors, and if it’s exposed to a higher concentration, it could probably potentially help.

Do you use PRGF injection in both low responders and diminished of our reserve patients or even advanced age patients?

Yes, they are often combined, so if we want to increase the egg yield, we do it. Many of these patients indeed have a poor prognosis, meaning that maybe they already have done treatments with us, these patients possibly have failed cycles behind them done at our centre, so these are not easy patients, and then since this PRP treatment has become available, we try to offer them something new. Low responders, diminished ovarian reserve, and advanced age patients are good candidates unless we see it’s not necessary, but it’s more the exception.

What is exactly considered diminished ovarian reserve, is there a specific number of eggs, and stimulation?

There are 2 groups, the Bologna criteria and the Poseidon criteria. It is based on an AMH level, of 1.2 nanograms per millilitre, for example, and if somebody has such a low value, then this patient already qualifies as a diminished ovarian reserve patient. Also, if someone has a previous history of ovarian stimulation, if there are 3 eggs or fewer, it is definitely qualified as a lower ovarian reserve patient.
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Authors
Daniel Bodri, MD, MSc, PhD

Daniel Bodri, MD, MSc, PhD

Dr Daniel Bodri MD, MSc, PhD is a Gynaecologist at IVF-Life. Dr Bodri completed his medical speciality training at Semmelweis University (Hungary) and worked in renowned fertility centres in France, Spain, Japan and UK. He obtained a Master of Science (MSc) degree in Clinical Embryology and a Doctor of Philosophy (PhD) degree in Obstetrics and Gynaecology from the University of Leeds (UK) and the Autonomous University of Barcelona (Spain), respectively. Ovarian stimulation, egg donation, time-lapse imaging and evidenced-based medicine constitute are his main areas of research.
Event Moderator
Caroline Kulczycka

Caroline Kulczycka

Caroline Kulczycka is managing MyIVFAnswers.com and has been hosting IVFWEBINARS dedicated to patients struggling with infertility since 2020. She's highly motivated and believes that educating patients so that they can make informed decisions is essential in their IVF journey. In the past, she has been working as an International Patient Coordinator, where she was helping and directing patients on their right path. She also worked in the tourism industry, and dealt with international customers on a daily basis, including working abroad. In her free time, you’ll find her travelling, biking, learning new things, or spending time outdoors.
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