In this webinar, Dr Anna Voskuilen Gonzalez, Specialist in Reproductive Medicine at Fertty International, Barcelona, Spain, has been discussing the PRP method, which might be a way to stop the fertility ticking clock.
Dr Gonzalez started her presentation on ovarian rejuvenation by explaining a bit about fertility and age. Women are born with a certain ovarian reserve, and that decreases with age, the decrease becomes more rapid after 35-37, and 40 years and is accompanied by a decrease in terms of oocyte quality. The number of follicles decreases until menopause, when up to 1000 follicles could still be in the ovaries. We can test the ovarian reserve but not the oocyte quality, which is related to age. After 40 years old, there’s difficulty in getting pregnant, there’s a higher rate of miscarriage, and there are more chromosomally abnormal embryos. To check the ovarian reserve, we test that with blood tests like FSH and estradiol, which are done at the beginning of the cycle, and we test, the AMH level (Anti-Müllerian hormone), which is produced by pre-antral and small antral follicles. It does not vary during a cycle, so any woman can do such a blood test whenever she wants to check her AMH level.
The last check is the ultrasound, in which we can do an antral follicle count, it’s possible to see the antral follicles in the ovaries, and those follicles have a bit of liquid inside, and that’s the reason we can see them. Those can be stimulated, and they grow and then become mature oocytes.
In a natural cycle, there is a certain number of antral follicles in each ovary, and all of them could grow, but we don’t have enough hormones for all of them to grow, and generally, 1 follicle grows, and we get 1 egg, and we ovulate just 1 oocyte, and that’s the reason people normally have babies 1 by 1. With IVF treatment, it’s possible to use the available antral follicles and make them grow in response to treatment with hormones and try to get mature eggs.
Until now, nothing has proved to help us increase the number of antral follicles so the basal ovarian reserve parameters. Since it is related to the total amount of ovarian reserve and because the growth of the follicle has an initial preantral phase that is independent of the hormones that we can give. The development of the follicles before the antral follicle stage is still not clearly understood. Some hypotheses have been studied, but more research is still needed to understand them clearly.
Ovarian rejuvenation techniques
Is it possible to increase ovarian reserve parameters?
- in an older follicle, the problem is that there’s a decrease in DNA repair, and there are problems dividing the distribution of the genetic material
- there is also ovarian hypoperfusion, a lower blood supply, which makes it more difficult for the oocyte to repair or mitigate the microstructural damage
the ovarian rejuvenation technique should not only increase ovarian reserve parameters, but also the quality of the oocyte. The main goal is achieving a full-term pregnancy with a healthy baby.
Some different techniques are still being studied, and one of them is PRP treatment (Platelet-Rich Plasma (PRP), but there are others, such as stem cells infusion, and ovarian rejuvenation surgery, which is achieving molecular activation by the fragmentation of the tissue).
Platelet-Rich Plasma (PRP)
What are platelets?
- they are derived from megakaryocytes which are big cells that in response to different stimulating factors release a little portion of cytoplasm
- platelets are unnucleated cells created from megakaryocytes that have different functions. One of them, the most known, is the first response in hemostasis, but they have also roles in tissue repair, neovascularization and immunomodulation
- all these functions are achieved due to the granules that are in the cytoplasm, which contain different growth factors, and that will be released in response to some tissue damage and others
PRP treatment injection has already been used in other fields, such as traumatology (tendinitis, arthritis), dermatology (hair growth, healing of wounds), and odontology. It is also studied in other fields of fertility, like the treatment of refractory endometrium.
PRP procedure can be indicated in patients with poor ovarian response or premature ovarian insufficiency, perimenopause or menopause.