If you had a failed IVF cycle, poor egg quality, or poor embryo quality, you may have been told that ovarian rejuvenation could help you improve your chance of success with a future IVF cycle.

The world of infertility treatments is still fairly new, with the first IVF baby being born in the late 70s. Since then, the more we understand about fertility, the more technology is being added to help women and men struggling with infertility to have children of their own.

Fertility doctors are now starting to offer ovarian rejuvenation as part of fertility treatment.

Ovarian rejuvenation is the term used for platelet-rich plasma (PRP) injections used to improve fertility, specifically egg quality.

So how can PRP improve your chance of getting pregnant and what does it entail?

We spoke with Dr. Zaher Merhi of Rejuvenating Fertility Center to understand everything you need to know about ovarian rejuvenation for IVF.
 

Ovarian Rejuvenation is the injection of platelet rich plasma (PRP) into the ovaries, specifically to help women with low egg reserves improve the quantity and/or quality of their eggs and improve their chances of getting pregnant.

The PRP injections are done at a fertility clinic by a reproductive endocrinologist. Usually, this treatment is done for women who had poor outcomes with IVF and are looking to improve their egg quality and embryo quality.

Ovarian PRP is used for women doing IVF to treat: 

Ovarian PRP injections can improve egg quality in women who have had poor outcomes previously with IVF.

In fact, Dr. Merhi shared in our video interview with him on ovarian rejuvenation that in a recent study of theirs, women who had previously had a high percentage of abnormal embryos were 4 times more likely to have PGT normal embryos after these PRP injections.

Platelet-rich plasma, known as PRP, is actually isolated from your own blood. So your doctor isn't injecting anything back into your body that wasn't already there. 

In the process, your doctor takes some vials of your blood, processes the blood to remove the red blood cells and leave the factors that your body uses to repair itself when you're hurt, primarily platelets.

This platelet-rich plasma is then injected into the tissue that require healing or regeneration. In this case it's he ovaries, where your eggs are housed.

So, it's just injecting plasma from your own body back into a different area of your body? 🤷‍♀️

Yes, however, it depends on the provider you're working with whether they also add in any other factors in with the platelet-rich plasma.

Dr. Merhi highlighted that at his practice, they just use your blood, they don't add anything to it. 

Some clinics do add certain things to the PRP, such as calcium, before injecting it into your ovaries.

The PRP process is quite simple.

First, thing to know is that not all fertility clinics offer PRP. If you're looking to find out which clinics offer Ovarian Rejuvenation, you can search fertility clinics in your area here and filter to find a clinic that offers this treatment.

To have ovarian rejuvenation done, you go in to the fertility clinic, have blood drawn, and wait for the lab to process your blood to remove any red blood cells. Some clinics also add extra factors to the PRP and some don't. So make sure to ask your clinic how they prepare the PRP.

Once the PRP is ready, your fertility doctor will perform the injections similar to how an egg retrieval for IVF is done.

Ovarian Rejuvenation (PRP for Fertility) steps:

The PRP is injected into areas around your ovaries by ultrasound-guided needle in the OR. The only big difference is that instead of the retrieving eggs, your doctor is now injecting PRP. 

Dr. Merhi noted that not every doctor has the same method for where they place the PRP. He injects into multiple areas around the ovaries in very specific spots.

So we know that the effects of ovarian PRP injections lasts about 3 months. But how long does it take to start working?

Dr. Merhi says that there are differing opinions among infertility physicians.

In his experience, it takes at least 2 weeks for the PRP to start working.

So those of you looking to start a new IVF cycle shortly after don't have to wait too long to see whether your egg quality improved and whether you had more normal embryos available.

The effects of ovarian rejuvenation don't last forever. 

Dr. Merhi says that the effects of the PRP injections last for about 3 months. After that, the effect is gone.

So within the next 3 months after PRP is a good time to start your next IVF cycle. 

If women had a good response to the treatment, they can always choose to do PRP again after the effects have worn off. 

Women planning on another round of IVF may want to do this if they saw positive results from their first PRP treatment. 

Dr. Merhi has found that in about half his patients, they have an improvement in their egg quality. 

But how is this happening? How is the PRP improving egg quality? 

They think it's helping with DNA division in the egg!

Dr. Merhi had a great explanation that he shared in our video about PRP for egg quality.

Your eggs are each developing in a follicle in your ovary. As you go through an IVF cycle, the fertility medications you take stimulate these follicles to grow in size and each develop an egg. 

When your follicles are less than 10mm in size, your eggs are still immature, meaning that they have not yet split their DNA in half. 

Eggs actually start out having a full set of chromosomes, just like your other cells, they have 46 chromosomes, or two pairs of 23 chromosomes. In order to make room for a sperm to provide half the genetics of a baby, the egg needs to remove one set of chromosomes, so that it's only holding half of the genetic material needed to create an embryo.

Human cells have 46 chromosomes. By the time your follicles grow to 16-22mm in size, the egg has split its DNA in half to only hold 23 chromosomes. 

The egg is now considered to be mature and is ready to be fertilized by a sperm that will provide the other 23 chromosomes needed to make a baby.

The theory behind PRP improving egg quality is that when the follicles are developing an egg, sometimes the eggs split their DNA unevenly, which means that the egg either has too few or too many chromosomes. 

So instead of the egg having 23 chromosomes, maybe it has 24 or 22. 

If the egg doesn't have the correct number of chromosomes, once the sperm is added, the resulting embryo is abnormal and either fails to develop normally or fails to implant.

So women that have had a lot of abnormal embryos during IVF could now potentially have PRP treatment, which could lead to their eggs now dividing their DNA evenly and lead to having normal embryos that have the correct number of chromosomes.

If you have low AMH, then you likely have a low egg reserve.

According to the CDC's IVF reporting, 28% of IVF cycles in 2020 included a diagnosis of diminished ovarian reserve. So a lot of women who are trying to get pregnant are dealing with having a low number of eggs available for IVF.  

A recent study looking at women with low ovarian reserve measured changes in AMH in two groups of women, one group had PRP treatment and the other did not.

They found that the group of women that did PRP treatment showed a significant improvement in AMH versus the group that did not have treatment.

Ovarian rejuvenation is still a new treatment, which means that we need much larger sample sizes for any statistics to be helpful here.

However, Dr. Merhi noted that PRP works in about 50% of his infertility patients. In the other half, he says, "it's as if you gave them nothing at all", there is no effect.

We don't yet know why this is that some women see a benefit while others don't. More research is needed in order to understand what exactly is happening.

The short answer, yes. As Dr. Merhi mentioned, some women do very well with ovarian rejuvenation and go on to have children using their own eggs.

A recent study of women with severe diminished ovarian reserve, known as primary ovarian insufficiency, showed that some of the women had babies through IVF and some even conceived naturally after doing ovarian rejuvenation.

The study included 311 women with primary ovarian insufficiency. After PRP treatment, 7.4% of women conceived spontaneously.

Of the women that did IVF, 41% developed embryos and had a 22.8% pregnancy rate per embryo transfer.

In total, 8% of the entire group conceived (either through IVF or naturally) and another 8% froze embryos for later use.

Many women who have poor egg quality or a low ovarian reserve often turn to donor eggs in order to get pregnant.

For women considering donor eggs. it may be worthwhile to look into ovarian rejuvenation to see if PRP can improve help you to have a baby using your own eggs.

Dr. Merhi has a great point, that donor egg isn't always an option for religious or financial reasons, so PRP can be the only option that some women have in order to conceive.

He offers PRP treatment at his practice for these women because he has seen success with ovarian rejuvenation for women who have had failed IVF cycles in the past.

To learn more about Dr. Merhi's clinic and his team, check out Dr. Merhi's FertilitySpace profile for contact details and more information.

If you want to find a clinic that offers ovarian rejuvenation (PRP), head to our clinic directory to find doctors in your area.