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PRP: Uterine and ovarian rejuvenation advanced techniques

Dr Oliver Pack
Fertility Specialist

Category:
PRP & Ovarian Rejuvenation

PRP-IVFWEBINAR_IVF-Life
From this video you will find out:
  • What are the key principles and goals of uterine and ovarian rejuvenation techniques?
  • What criteria are used to determine suitable candidates for uterine and ovarian rejuvenation?
  • How are the procedures performed, and what is involved in the process?
  • What can patients expect in terms of results following uterine and ovarian rejuvenation?

PRP: Uterine and ovarian rejuvenation advanced techniques

During this session, Dr Oliver Pack, Fertility Specialist 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 on 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.

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- Questions and Answers

Does PRP improve egg quality? My last 4 blastocysts were aneuploid, I’m 41 now.

Unfortunately, PRP does not improve the genetics of the egg, especially in cases of aneuploidy. It strongly depends upon the quality of the eggs, and PRP cannot improve that. If a woman has had 4 unsuccessful attempts at pregnancy and is 41 years old, her chance of success is likely lower than average.

If we do PRP, can we achieve more embryos and increase chances?

PRP can potentially help achieve more embryos, but it primarily focuses on improving egg quality. It might increase your chances of finding a suitable embryo for transfer, but it’s not a guarantee.

When exactly and how many times to do PRP before IVF?

PRP can be applied at any point in the menstrual cycle, or even in menopausal women. It takes between 1 and 3 months to take effect. Usually, it’s done once in the first cycle, and some couples opt for a second application. However, there’s no scientific evidence that multiple applications are better.

What about endometrial PRP?

Endometrial PRP is more common and has been used for about 8 years. It’s helpful, especially in cases with atrophic linings or where implantation has failed. While there’s ongoing research to prove its efficiency, many practitioners believe it works.

For Frozen Embryo Transfer, when should PRP be done?

Endometrial PRP for frozen embryo transfer is done via hysteroscopy. It’s typically performed after a short period of bleeding, usually a week after stopping birth control pills. Installations with PRP are done during the growth of the lining between days 10 and 15.

Best ways to put PRGF into the ovarian cortex and how to control hormonal levels?

PRP is infiltrated near the ovarian cortex, not directly into it. It doesn’t require stem cells. Hormone levels, such as AMH and FSH, are monitored for effectiveness, but stem cell application is not currently used.

Is PRP safe in terms of causing cancer in the future?

PRP is considered safe and does not cause cancer. It’s essential to avoid it in patients with a history of ovarian cancer and those with endometriosis in their ovaries.

Would you recommend random endometrial PRP washing in repeated implantation failure?

Yes, endometrial PRP washings can be beneficial in cases of repeated implantation failure. It’s often used alongside other PRP treatments for better results.

If you have embryos and optimal endometrial surrounding, would you continue until it implants?

The decision of how many attempts to make depends on various factors, including age, personal choice, and medical history. Typically, patients have a few attempts, often 3 to 4, but it can vary based on individual circumstances.

Would you recommend transvaginal PRP or laparoscopic PRP?

Transvaginal PRP is the preferred method, as it is less invasive and easier to perform. There is no clear reason to choose laparoscopic PRP over transvaginal PRP.

How long does the effect of endometrial PRP last?

The effect of endometrial PRP typically lasts up to six months. It may vary from person to person, but this is a general estimate.
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Authors
Dr Oliver Pack

Dr Oliver Pack

Dr Oliver Pack was born in Solingen, Germany. In 1994, he travelled to Spain to start his medical studies. In 1999, he obtained his title from the Universidad de Salamanca. Soon after, he started his General Practitioner specialisation at the General Hospital of Alicante. His interest in closeness to the patient and personalised treatment motivated him to specialise in Reproductive Medicine. In 2018, he became part of IVF Spain's medical team.
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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