We are going to be discussing today, using PRP for ovarian rejuvenation.
PRP and ovarian rejuvenation is? Well, PRP stands for platelet rich plasma, and so it’s an extremely simple procedure, as long as you know how to do it. But PRP itself has been around for about 30 years and it’s very commonly used in several different areas of medicine, including orthopedic surgery, plastic surgery, cardiac surgery, even neurosurgery. And what it involves doing is using the growth factors that are released from platelets to enhance the effect of whatever the surgical procedure is. So it’s extremely common for any athlete who’s been injured to place PRP in the area of injury as well as whatever the rest of the treatments are used.
The best part, it works extremely well. And so I think the concept of using it for ovarian rejuvenation, which means to take the ovary and actually rejuvenate it, take it back to a younger age, was very exciting to begin with. We didn’t know if it was going to work or not, and it’s actually worked much better than we thought that it would.
Initially we thought about stem cell and PRP, it was always around a lot of orthopedic procedures and worked very well for my brother when he was dealing with his knee issues. And I thought it was a very logical next step in progression to take it to ovarian rejuvenation. So I was happy to see that that was being done.
We have done a lot of stem cell work in the past and so when I heard that people were using stem cells in an attempt to rejuvenate the ovary, it’s an interesting idea. However, it simply does not work. It’s extremely expensive and it doesn’t work. And the US government and many other organizations and agencies had pointed that out, that taking stem cells and injecting them into the blood and hoping that they get to the ovary and hoping that they differentiate into the correct
cells to actually enhance fertility, it’s a crazy idea done right now. And the interesting thing to me about PRP is it’s actually based on the same idea.
So when you inject PRP and the growth factors are released as a result, what happens is, the stem cells within the ovary actually begin to grow and differentiate much as they do when a person is injured and platelets go to the area to help heal the injury. So what we’re doing is stem cells right, in a sense, because we’re activating the ones that are already there. We’re not activating stem cells that have no particular appearance, nothing like that and hoping that they differentiate into what we want.
We’re actually taking those stem cells and differentiating them according to what’s already there at the ratios that are already there. And I think that’s the reason it works so well. That’s a great differentiation and clarification because I think there’s many people who think that stem cell and PRP are one in the same and they’re not. Definitely different procedures and it’s a different process.
How long is the process for someone who wants to, let’s say they reach out to you saying that they want to start this process of ovarian rejuvenation and they want to incorporate PRP. What’s the timeframe that they have to go through and when should they actually think about reaching out so that they have enough time to put this into place? It’s a really good question. When we started, we didn’t know how long it would be effective. And what we do now to look at effectiveness is we look at AMH levels, Anti-Mullerian Hormone levels, in about 70% of women, those levels go up.
Now AMH is made by follicles. The more follicles you have, the higher the AMH is going to be. And so when we looked over time at what happened to AMH, we saw that some women, it would only be elevated for one month or two months. The longest we’ve seen is in the range of
six months. The time to do it is right before you plan on doing a treatment cycle.
And so we actually have two different ways of doing it. We take care of many patients from other countries and they’re usually not able to come and stay for six to eight weeks. Instead, they’re only here for two weeks. And so we do pretreatment before they arrive and then when they arrive we do the PRP. And then we start the cycle immediately. So the PRP is done roughly two weeks before the egg retrieval in an IVF cycle. If it’s someone who has more time or who is a domestic patient, what we generally do is the PRP, then start pretreatment for four weeks and then do the stimulation for another two weeks. And so in that case, it’s six weeks from the time that we do the PRP until we do the egg retrieval. And the reason we do that is I don’t want to miss it. And in the past sometimes we would do that. We would see a very nice rise and then we would see it trail off.
And by the time we knew it had trailed off, it was too late to actually do the IVF cycle. And so the patients didn’t gain all the benefit from it that they could. And so this particular strategy has worked very, very well. We’re seeing,70% of women responding and I just had another patient on Friday who went from roughly 0.6 up to 1.7 AMH in the space of four weeks. And so we’ve seen many dramatic results. Unfortunately it’s not a hundred percent, but things are going very well. I think 70% is a good percentage to have. I don’t expect anything to be a hundred percent so those are good results. So that’s interesting because I was thinking that they wanted several rounds of PRP to give them the better result. But what you’re seeing is actually immediate effect right after in that same cycle, which is excellent.
That makes it a lot easier for patients. In the past we have had patients that did multiple cycles, but I think it was in part because of the way we were doing it. Now that we’re using the new technique, it’s much less common because we see very high response rates. At the beginning it was 30 to 50% of women would respond and when they didn’t respond, they’d come back and we’d do another injection of PRP. And then in some cases we’d see a response then when we didn’t at the beginning. So I think it’s a lot of the benefits that we’re seeing now and the speed with which we see those benefits come from the new technique.
And then they would reach in with a grasper and they lift the ovary up and they would inject the PRP into the ovary. The problem is that the ovary is white on the outside. You can’t see through it, it’s not transparent. And so many of the injections that they made into the ovaries were blind. Now we know exactly where the eggs are in an ovary. And so when we started doing it via ultrasound, which allows you to see throughout the ovary, now we’re able to place it precisely, exactly where the eggs are. We have seen much better results.
Now, PRP actually does two things The first is to increase the number of eggs. Because when you see an increase in AMH that’s really of no value by itself. An increased AMH doesn’t help you. But if it’s reflective of an increased number of follicles, increased number of eggs, then it does. What’s the other way it helps? It increases the quality of the eggs and eventually the embryos. And so we’ve had patients, where they failed many, many cycles. And the reason they failed is they got blastocyst, which are the stage of embryo in which implantation occurs. But when they were tested, they were abnormal. So cycle after cycle, they would make eggs, they’d make embryos, but they’d be abnormal. But when you do PRP first, the chance that you’re going to get a normal embryo is higher.
And that’s really the key because when you transfer a normal blastocyst and you transfer it gently and you transfer it in an optimal way, pregnancy rates are extremely high, they’re around 90%. Very, very high. So it’s really getting to that stage where you have a normal embryo, a normal blastocyst. That’s really the key. And so all of our efforts, including ovarian rejuvenation are all around accomplishing that, because without that you have nothing. We are also seeing that translate to less miscarriages. Miscarriage rates are probably 20% or so if you don’t do PGS for example, then they dropped a 5% if you do. So we’ve had some patients that had miscarried repeatedly and then after doing PRP, they didn’t miscarry. These are not perfect studies because there’s no randomization, but at least apparently it helps in terms of that as well.
In order to to obtain PRP, you draw a patient’s blood. Usually you obtain 10 to 15 milliliters or CCs of blood and then you isolate the platelets from the blood sample. You then activate the platelets and when you activate them, the platelets release these growth factors. At that stage you draw platelets and the growth factors and inject them into each ovary.
When you do PRP, you’re injecting the platelets and those platelets continue to release growth factors probably for three days.