During this live session, Dr Elias Tsakos, MD, FRCOG, Medical Director of Embryoclinic, Greece, explains the latest advances in PRP (Platelet-Rich Plasma) therapy and ovarian rejuvenation.
Learn about:
– What PRP therapy is and how it works in fertility treatment
– Who may benefit from PRP and ovarian rejuvenation
– Current research, clinical insights, and patient outcomes
– The potential role of PRP in improving IVF success rates for women with diminished ovarian reserve
Perfect for women with low AMH, poor ovarian response, or early ovarian ageing, exploring options to boost fertility.
Low ovarian reserve remains one of the most challenging diagnoses in reproductive medicine. For many women, it raises urgent questions about time, treatment options, and whether there are any alternatives before considering egg donation. In this educational webinar, Elias Tsakos, Medical Director of Embryoclinic, shared a detailed, evidence-based overview of platelet-rich plasma (PRP) and its emerging role in fertility treatment, particularly for women with poor ovarian response.
Speaking to an international audience, Dr Tsakos emphasised caution, transparency, and realistic expectations while explaining where PRP may offer potential benefits and where its limitations remain.
PRP, or platelet-rich plasma, is an autologous product derived from a patient’s own blood. After blood is drawn, it undergoes a specialised centrifugation process to separate and concentrate platelets, which are rich in growth factors, peptides, and anti-inflammatory cytokines.
Dr Tsakos explained that platelets play a central role in tissue repair and regeneration throughout the body. In other medical fields such as orthopaedics, dermatology, and sports medicine, PRP has been used for many years. Its application in reproductive medicine, however, is relatively recent.
He stressed that PRP does not involve donor material or medications and is produced entirely from the patient’s own blood, reducing concerns related to immunological reactions or rejection.
While PRP is often referred to as “ovarian rejuvenation” in popular media, Dr Tsakos expressed reservations about the term. He noted that it may create unrealistic expectations and oversimplify a complex biological process.
Rather than “rejuvenating” the ovaries, ovarian PRP aims to improve the ovarian environment. This may involve enhancing blood supply, supporting follicular development, and potentially improving the conditions in which remaining follicles grow.
As Dr Tsakos explained:
We are not treating AMH levels. We are trying to produce competent oocytes that can lead to good-quality embryos and, ultimately, a healthy child.
PRP can be administered to the ovaries using two main approaches:
The vaginal (transvaginal) route
This method is similar to egg collection during IVF. Under ultrasound guidance, PRP is injected directly into the ovaries through the vaginal wall. While less invasive for the patient, the procedure can be technically challenging, especially in women with very small, atrophic, or mobile ovaries.
The laparoscopic route
In cases where the vaginal approach is not feasible or optimal, PRP can be injected during laparoscopy (keyhole surgery). Dr Tsakos highlighted several advantages of this method: direct visualisation of the ovaries, precise injection depth and placement, and the opportunity to perform a full diagnostic assessment of the pelvis. Conditions such as endometriosis or adhesions can be identified at the same time.
The choice of approach, he emphasised, must be individualised based on each patient’s anatomy, history, and overall clinical picture.
There is currently no universal agreement on the optimal timing of ovarian PRP within the menstrual cycle. Some studies suggest it may be beneficial in the first half of the cycle, while others report no significant timing effect.
Dr Tsakos noted that many published studies do not clearly specify when PRP was administered, contributing to variability in outcomes. In clinical practice, timing is often influenced by practical considerations and the patient’s treatment plan.
Preparation of PRP itself is highly protocol-dependent. At Embryoclinic, Dr Tsakos described a rigorous process developed over more than a year, including quality control measures to ensure clarity, sterility, and appropriate platelet concentration before injection.
Dr Tsakos reviewed recent scientific data, including meta-analyses published in 2024, which have examined the effects of ovarian PRP in women with low ovarian reserve.
Reported findings include:
– modest increases in AMH levels within 2 to 3 months in some patients
– an increase in antral follicle count
– fewer IVF cycle cancellations due to poor response
– a small increase in the number of retrieved oocytes
– in some studies, approximately one additional euploid embryo per cycle
However, he was clear that the overall quality of evidence remains limited. Many studies are small, non-randomised, or heterogeneous in design. As a result, PRP is not currently endorsed as a standard IVF add-on by major scientific societies.
There is a trend suggesting it may be useful and does not appear harmful, Dr Tsakos explained, but the evidence is not black and white.
Based on both published research and unpublished clinical data from Embryoclinic, Dr Tsakos outlined a subgroup of patients who may be more likely to benefit from ovarian PRP.
These include:
– women under approximately 43 years of age
– women who are not menopausal
– patients without known chromosomal, DNA, severe immune, or major hormonal abnormalities
– women with idiopathic infertility and low ovarian response
– patients who have already undergone thorough fertility investigations
Conversely, he stated that menopausal women are unlikely to benefit, and PRP should not be presented as an alternative to egg donation in cases where ovarian function is no longer present.
Throughout the presentation, Dr Tsakos repeatedly emphasised the importance of avoiding exaggerated claims. He cautioned against marketing PRP as a “one-size-fits-all” solution or a guaranteed alternative to egg donation.
Yes, it may be an option,” he said, particularly before egg donation for women who have tried everything else. But it is not a panacea.”
He stressed that PRP should only be offered following careful patient selection, full counselling, and with realistic expectations about possible outcomes.
In addition to ovarian PRP, Dr Tsakos briefly discussed endometrial PRP, where the evidence appears more robust. In women with thin endometrium, repeated implantation failure, or a history of uterine surgery, PRP may improve endometrial thickness and receptivity.
He noted that the endometrium is a simpler tissue than the ovary, making it a more predictable target for regenerative therapies.
Dr Tsakos shared a recent clinical example to illustrate both the potential and the unpredictability of PRP. A 46-year-old patient with a previous very poor response produced 7 oocytes, 6 of which fertilised, following ovarian PRP after an unsuccessful cycle 3 months earlier.
While he described this as an exception rather than the rule, it highlights why PRP continues to attract interest and ongoing research.
The webinar concluded with a call for high-quality, multicentre, prospective studies to better define the role of PRP in fertility treatment. Dr Tsakos explained that his team is actively seeking international collaborators to contribute to more robust data.
Until then, PRP remains an experimental option that may be discussed with carefully selected patients as part of an individualised treatment strategy.
PRP represents a promising but still evolving approach in reproductive medicine. As Dr Tsakos made clear, its value lies not in bold claims, but in careful application, scientific integrity, and honest communication with patients.
For women facing low ovarian reserve, PRP may offer a small window of opportunity in specific cases, but it should always be considered within the broader context of evidence-based fertility care, patient well-being, and informed choice.
Based on the lifespan of follicles, I would expect the maximum effect within three months, around 90 days. Current research shows that AMH may increase 1, 2, and 3 months after PRP. I do not think PRP needs to be repeated sooner than 3 to 4 months, and the peak effect is usually seen within that 3-month window.
To be clear, I rarely repeat PRP. I have done it twice, only in cases where I was not satisfied with the vaginal approach and then opted for the laparoscopic route. In about half of those cases, undiagnosed endometriosis was discovered. I do not see any particular benefit in repeating vaginal PRP if the first procedure was technically successful, quality control was good, and platelet concentration was adequate.
If the platelet concentration is between 800,000 and 1.5 million per microlitre and the injection is done correctly, one treatment is usually enough. If AMH does not increase and I am not confident that the ovary was punctured properly, then I may repeat the procedure laparoscopically. Otherwise, I am happy to continue IVF cycles back to back or alternate stimulated cycles with natural cycles over the next four to five months. This is not a single isolated treatment. I ask patients to allow four to six months to maximise the chance of retrieving as many eggs as possible.
At the moment, nobody truly knows. My team and I are studying this method and reviewing the evidence, but we do not yet have clear answers. We are not currently using cytokine-rich serum because we are not convinced by the existing data. It may become a future option or be combined with PRP, but scientifically we are still far from being able to compare these treatments head-to-head. If I had to choose today, I would still go with traditional PRP, although even PRP itself is still under investigation.
The clear answer is no. There is no evidence that PRP improves embryo quality or euploid rates. The most important factor for embryo quality remains female age, and PRP does not change that.
What PRP may improve is the ability to retrieve one more egg on average. For a poor responder, even one additional egg can be a significant improvement. This does not happen in every case. However, with careful patient selection and a technically correct procedure, we see value.
In our clinic, we often perform PRP during laparoscopy in poor responders or women aged 38 or 39 and above when laparoscopy is indicated for another reason. Laparoscopy provides valuable diagnostic information, including the detection or exclusion of endometriosis. In our hands, PRP performed laparoscopically has been more effective than the vaginal route. This approach is not for everyone, but it may benefit selected patients.
There are case reports of spontaneous pregnancies up to the age of 46. These are individual cases, not large studies.
I cannot disclose prices publicly. However, anyone who wishes to receive an individualised quote can contact the clinic directly, and we will be happy to provide detailed information based on individual circumstances.
PRP itself is not linked to PCOS-related complications. However, PCOS carries an increased risk of gestational diabetes and pregnancy-related hypertension. With proper diagnosis and management before and during pregnancy, these risks can be minimised. The vast majority of women with PCOS do very well during pregnancy.
Improvement in LH and FSH is positive. However, success should not be judged solely by hormone levels. The most important indicator is the response to ovarian stimulation. In my experience, the peak effect of PRP is seen at around three months. I usually recommend mild stimulation alternating with natural cycles during this period. The goal is to collect 1 or 2 eggs per cycle and gradually build embryos rather than focus on immediate hormone changes.
AFC is important, but it is only one factor. AMH is generally more objective than AFC, which depends heavily on equipment quality and operator experience. If a woman is still menstruating, small follicles are likely present, even if AFC appears low or zero. PRP is never a first-line treatment. The most important test of ovarian reserve is the response to stimulation. A mild stimulation should always be attempted before considering PRP.
An AFC of 7 at age 39 is very good. I would not recommend PRP without first attempting stimulation. PRP should be considered a last resort before egg donation. In this case, optimising overall health and proceeding with standard ovarian stimulation would be the appropriate first step.
Yes, provided the duration of infertility has not been very long and essential factors have been properly assessed. This includes detailed sperm testing, tubal patency, and high-quality 3D or 4D ultrasound imaging. Standard ultrasound alone may be insufficient. If all key factors are favourable, natural conception may also improve after PRP.
Probably not. Recurrent miscarriage should be thoroughly investigated first, including hormonal, genetic, infectious, anatomical, and male factors. PRP should not be considered before completing these investigations.
