REJUVENATION TREATMENTS (PRP)
PRP (Platelet Rich Plasma) is blood plasma that has been enriched with platelets prepared from fresh whole blood using a centrifuge process. It is derived from the patient’s own blood.
PRP contains growth factors and many other components, including proteins with antibacterial and anti-inflammatory properties as well as coagulation factors, which promote tissue healing, improve blood supply and eventually play a fundamental role in the tissue regeneration.
Although PRP has been applied for many years in various areas of medicine including Cosmetics, Cardiac surgery and Orthopaedics, it is relatively new to the field of Fertility. The injection of PRP in damaged or atrophic tissues is considered to promote tissue healing and regeneration of the cells, hence the potential use in Fertility and IVF.
In women with fertility issues PRP is used to thicken the resistant endometrium and revitalise the non-functioning ovaries in an attempt to restore some ovarian function and boost the egg production.
Although the clinical evidence is in preliminary stages and the ovarian PRP application is still a very new practice, existing data suggest incredible outcomes in patients even in menopausal stages.
The contribution of PRP treatment in the reestablishment of the menstrual periods and the regeneration of the follicles, either through the development of the existing follicles, or through the generation of new follicles derived from the inactive ovarian tissue, remains a controversial topic.
Since PRP is an innovative technique, more research is needed to establish whether it could be advised as a reliable method for infertility management in women with low ovarian reserve and advanced age.
PRP could be proven beneficial in the following group of patients:
- As a last resort treatment for women with repeated implantation and IVF failures not keen to go down the egg donation route.
- Women with low ovarian reserve (usually diminished AMH values)
- Women with premature ovarian insufficiency (POI) or early peri-menopause.
- Women with chronic inflammation of the uterine lining.
- Women who cannot obtain a desired level of endometrial thickness for a successful embryo transfer.
PRP has been deemed very safe since it involves the use of the patient’s own blood to infuse the ovaries and is a minimally invasive procedure.
As with all surgical procedures, there are potential risks associated with the ovarian PRP injection. These include:
- Mild to moderate discomfort.
- Bleeding during or after the PRP injection, either from the ovary or from the needle puncture site at the top of the vagina. The bleeding is usually minimal and very rarely causes a problem. The need for blood transfusion is rare, in the region of 1 in 500.
- Infection is also a rare complication and can be treated with antibiotics. The risk is in the region of 1 in 300.
- Injuries to internal organs such as bowel, bladder or blood vessels during the procedure. This is an extremely rare complication, in the region of around 1 in 1000.
PRP injection in the ovaries aims to activate the growth and the proliferation of the cells in the ovaries. In an attempt to revitalize the egg production from the ovaries, each ovary is injected with a few mls of PRP. It is a procedure similar to the egg collection but in reverse and the only difference between the two procedures is that instead of aspirate, the ovaries are infused. The precise number of eggs expected to be produced following the PRP treatment cannot be specified, since this depends on the condition of the ovary before the treatment and the response of each individual to the treatment.
This can be offered as an alternative therapeutic approach in women suffering from chronic endometritis, recurrent implantation and IVF failures as well as in women who cannot obtain a desired level of endometrial thickness for a successful embryo transfer. The procedure is similar to an IUI and involves the infusion of PRP into the uterine cavity.
The following blood tests are essential prior to your PRP treatment:
- A Full Blood Count (FBC) and CRP done within a week preceding your PRP scheduled date.
- FSH, AMH and E2 (Estradiol) done within 3 months preceding your PRP scheduled date.
- A full virology screening including testing for Hepatitis B, Hepatitis C, HIV and syphilis (VDRL) done within 6 months preceding your PRP scheduled date.
Prior to PRP
On the day of the PRP you need to present at the clinic with a copy of your passport as well as a copy of the results of the required blood tests. You should be fasting from midnight the night before your procedure. Upon your arrival to the clinic you will need to give a blood sample. This blood will then be harvested with the aid of a kit to separate the plasma from the blood and further enrich it with platelets and growth factors. This process could last for up to 1 hour. Following that a nurse will accompany you to your room, in order for the final preparations of your PRP procedure to take place. That would involve signing the relevant consent forms and having a cardiology and anaesthetic review.
The PRP Procedure
The procedure is done under light sedation in theatre.
Ovarian PRP: A fine needle is inserted under ultrasound guidance through your vagina to reach your ovaries. Through this needle a few mls of PRP are injected into your ovaries. The procedure lasts for approximately 10 minutes.
Endometrial PRP: It involves the insertion of a speculum into the vagina in the same way as having a cervical smear test. A thin, soft catheter (tube) is then passed through the cervix into the womb. The PRP is then injected via the catheter into the womb.
Following your PRP procedure you will return to your room to rest for approximately 2 hours. Since this is a minimally invasive procedure, you will be advised to take orally painkillers (paracetamol) for the next 24-48 hours as well as antibiotics for a week. The recommended time of staying in Greece is two days. You may fly back home the following day.
All patients having PRP are advised to have certain investigations at monthly intervals following the procedure, to assess the response of the ovarian function (rejuvenation/ reactivation) to the treatment.
The investigations include a blood test to check the level of: Follicle Stimulating Hormone (FSH), Luteinizing Hormone (LH), Oestradiol (E2) and Anti-mullerian Hormone (AMH), as well as a trans-vaginal ultrasound scan done on the same day in order to measure the number of follicles present in each ovary.
Those exams should be done on the second day of the period or if there is no period any day at the beginning month, for three consecutive months after the PRP procedure.