PRP: Uterine and ovarian rejuvenation advanced techniques

During this session, Dr Oliver Pack, Fertility Specialist at IVF-Life Alicante explained uterine and ovarian rejuvenation with advanced techniques using PRP (Platelet-Rich Plasma), how it works, its indications and possible outcomes.

Dr Oliver Pack started by explaining that this innovative therapy harnesses the potential of growth factors to enhance tissue regeneration and has found applications across various medical fields.

PRGF, or autologous plasma, is derived from a patient’s own blood, ensuring a secure and side-effect-free treatment. This approach concentrates growth factors found in platelets, which play a crucial role in blood clotting. PRGF involves separating platelets from red and white blood cells, creating a potent plasma for therapeutic use.

Initially used in heart surgery in 1987 to regenerate heart muscle, PRGF has since found applications in various medical fields, including orthopedics, cosmetic and skin treatments, surgery, wound care, ophthalmology, neurosurgery, and even dentistry.

Types of PRGF (Plasma Rich in Growth Factors)

There are two types of PRGF—endometrial and ovarian. Endometrial PRGF is used to treat conditions like Asherman syndrome, adhesions, chronic endometritis, and implantation failure. Over time, it has been recognized for its impact on endometrial receptivity and embryo implantation, making it beneficial for patients facing recurrent implantation failure and miscarriage.

Ovarian PRGF can be used when the ovarian reserve is low. While it doesn’t rejuvenate the ovaries per se, it makes them more active. It increases the number of antral follicles, improving the potential for a higher egg yield during stimulation. This treatment is particularly relevant for premature ovarian failure, pre-menopause, and natural menopause.

The effectiveness of PRGF varies from patient to patient. Unfortunately, there are no definitive criteria to predict responsiveness. Therefore, patients and physicians need to consider the treatment carefully, understanding that success rates can range from 30% to 40%.

Ideal candidates for PRP in the ovaries are women with a low ovarian reserve but not extremely low. The treatment can double the number of eggs in these cases, making it a valuable option.

Best indications are women with an AMH between 0.5 and 3.5 picomoles per liter, where PRP can significantly increase the number of eggs.

Treatment protocol

A typical PRGF treatment involves infiltrating the PRGF during the first egg retrieval procedure. Patients may undergo between 2 and 4 IVF cycles, with each cycle spaced at least a month apart. This allows time for the PRGF to take effect. After collecting enough embryos, they are sent for pre-implantation genetic testing (PGT-A) to identify euploid embryos.

Patients may opt for embryo banking, aiming to collect multiple embryos and improve their chances of achieving pregnancy. The number of embryos needed depends on the patient’s age, fertility goals, and the likelihood of euploid embryos. It’s a strategy commonly introduced by couples seeking to have multiple children.

Outcome and success rates

The quality of embryos largely depends on the female’s age. Euploid embryos significantly increase the chances of implantation, with rates ranging from 70% to 90%. The overall pregnancy rate remains high, although miscarriages can still occur, as is common in natural pregnancies.

Conclusions

In conclusion, PRGF therapy offers hope to women facing challenges related to uterine and ovarian health. While its effectiveness varies, it has shown promise in improving endometrial receptivity and stimulating follicular growth. Understanding its potential benefits and limitations is crucial when considering this innovative treatment.