PRP (uterine & ovarian rejuvenation) – indications and prospects

During this session, Dr Estefanía Rodríguez, Medical Co-Director, Head of the Research Unit & Gynaecologist, specialised in Assisted Reproduction at IVF-Life Donostia discussed PRP treatment, the aim of ovarian and uterine rejuvenation and explained which group of patients it is recommended.

Dr Estefanía Rodríguez began with a brief overview of the concept of PRP and how it works. Then, also explored the effects of PRP on tissues, its application, and its objectives. Next, she delved into the candidacy for PRP therapy and the preparation of this treatment. Lastly, the event was focused on ovarian PRP procedures and Dr Rodríguez touched on the recommended strategy of embryo banking, followed by a discussion on endometrial PRP procedures and treatments.

Understanding PRP

PRP is an autologous plasma enriched with growth factors extracted from the patient’s peripheral blood platelets. It was first used in 1987 during open-heart surgery and has since found extensive applications in various medical procedures, including traumatology, surgery, and now, gynaecology. PRP can be used in both the uterus and ovaries to achieve rejuvenation.

The Effects of PRP

PRP promotes angiogenesis and vascularization in tissues. It stimulates cell migration and increases cell proliferation while reducing inflammation. Additionally, it stimulates the autocrine and paracrine secretion of growth factors. Numerous studies have demonstrated that PRP can enhance the proliferation and motility of endometrial fibroblasts, leading to an increase in endometrial thickness. This improvement in endometrial function can enhance implantation rates, ultimately aiding in achieving pregnancy.

Indications and Objectives

The use of PRP in the endometrium and ovary serves different objectives. In the endometrium, PRP can improve endometrial thickness, promote growth factor expression by endometrial cells, and enhance the function of the endometrium. This can be beneficial in cases of adhesions, atrophic endometrium, chronic endometriosis, implantation failure, and repeated miscarriages.

In the ovary, PRP can improve angiogenesis and vascularization, enhance follicular functionality, stimulate cell migration, and promote the autocrine and paracrine secretion of growth factors. This can be particularly useful in patients with low ovarian reserve, premature ovarian failure, perimenopausal issues, and menopausal symptoms. By reactivating follicular function, PRP can improve hormone production and overall quality of life for patients.

Contraindications and Evaluation

Before implementing PRP treatment, it is crucial to evaluate patients for permanent and temporary contraindications. Permanent contraindications include severe health diseases, a history of hepatitis B or C, active infections, and severe uterine abnormalities such as fibroids or an oncological history. Temporary contraindications may involve bacterial infections, blood disorders, autoimmune disorders, or generative diseases. Each patient’s case needs to be evaluated individually to determine the suitability of PRP therapy.

PRP Protocol for Ovarian Stimulation

When considering patients with conditions such as fibroids or a history of oncological or autoimmune diseases, careful evaluation is necessary to determine the suitability of PRP treatment. The PRP protocol involves stimulating the patient multiple times to introduce PRP into the ovaries. The menstrual cycle is typically initiated with hormone administration, followed by stimulation for the extraction of liquid from the follicles. Subsequently, PRP is introduced into the ovary. PRP preparation is performed in the clinic using a blood sample obtained from the patient. The centrifugation process separates the plasma and platelets from the blood, ensuring a safe treatment with minimal side effects. After PRP injection into the ovary, a one-month waiting period ensues, followed by the evaluation of ovarian markers through hormonal testing and ultrasound examinations. If positive changes are observed, indicating improved follicular function, a second stimulation can be initiated. However, if the results are not favourable, a wait of another month is recommended before reassessing the ovarian markers and repeating the ultrasound.

Accumulation of Stimulation Cycles and Embryos

In cases where multiple stimulation cycles are required, the embryos can be accumulated for better outcomes. The protocol involves performing oocyte retrieval on the day of follicle collection and then storing the embryos until the fifth day of development, as this provides higher chances of good-quality embryos. The ultrasound image shows the collection of liquid through a vaginal ultrasound. The extracted liquid is used to obtain the oocytes, and PRP is introduced into the ovaries. Although it is preferable to stimulate the ovaries before introducing PRP, in some cases, where no follicular activation is present, the liquid can still be introduced without prior stimulation.

Endometrial Preparation and PRP Application

When using PRP for endometrial improvement in patients with already existing embryos, the uterus is prepared for transfer. PRP is prepared using a blood sample and stored in the clinic. Once the uterus is prepared, PRP is introduced directly into the uterus or behind the endometrium using a hysteroscopy. The specific application method depends on the individual case. This procedure is usually performed three times, although the frequency may vary depending on the patient’s response. Multiple studies and protocols exist regarding PRP introduction, making it essential to continue gathering information and refining the treatment approach. Proper patient selection is crucial, and the current recommendation is to undergo PRP treatment three times, but adjustments can be made based on the ultrasound findings and endometrial thickness.

Embryo Banking Strategy

To optimize outcomes in women with low ovarian reserve, an embryo banking strategy is recommended. This strategy involves stimulating the ovaries two to four times over a period of two to four months. The goal is to collect between four and eight high-quality embryos. By studying the genetics of these embryos, the chances of transferring a chromosomally normal embryo with a high implantation rate can be significantly increased.

Conclusion

The use of PRP in fertility treatments holds promising potential. The team at IVF Life San Sebastián and Donostia specializes in utilizing PRP in various protocols to improve ovarian and endometrial function. Ongoing research and data collection are crucial for refining these protocols and providing better outcomes for patients.