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We offer this as an extension of the original PRP protocol pioneered in Greece. It is a quite safe and relatively new elective procedure in which platelets or platelet-derived growth factors are placed inside the ovaries in the areas that typically contain eggs. This is achieved by a near-painless injection through the top of the vagina under direct ultrasound guidance. No anesthesia is required.
In addition to other ways these techniques might be helpful, they may recruit ovarian stem cells so that they develop into eggs. If the number and/or quality of the eggs available for IVF is improved, the chance of pregnancy may also be improved and the need for donor eggs reduced.
Members of our team worked on the first registered “Ovarian Rejuvenation” human research study in the United States, as listed with ClinicalTrials.gov. To date, our group has safely completed hundreds of ovarian PRP procedures using established methodologies, including some with precision laboratory support from RegenLab (Lausanne) and Neokine.
Because ovarian PRP enriched platelet factor infusions involve the use of a patient’s own platelets rather than donor platelets, there is no risk of cell rejection or graft-versus-host reaction. The procedure is almost always well tolerated and there have been no adverse events or complications associated with either of these procedures as performed using our proprietary method.
Below we answer many of the questions we have received about this revolutionary technology from patients throughout the world.
If you’re really frustrated trying to become pregnant and feel it may be impossible for you because you’ve been told you’re “too old,” or that your AMH is “too low” or your FSH is “too high” or your eggs are “low or poor quality” or you “don’t make enough” of them or that all of “your embryos are abnormal,” we may have the perfect solution for you, one you won’t be able to find elsewhere in the world.
Ovarian Rejuvenation Generation 2!
First we draw blood from you. We then process that blood to isolate the platelets. Prior to each procedure, your vagina is prepared for the injections. In the case of the Ovarian Rejuvenation with PRP, the platelets are “activated” which causes them to begin releasing several growth factors. Using a vaginal ultrasound, the ovaries are identified, and activated PRP is injected into each accessible ovary in a special way. In the case of the Ovarian Rejuvenation with EnPLAF procedure, the platelets are held in an incubator while they release the growth factors into the fluid around them. This fluid, now filled with growth factors, is then injected into each accessible ovary, again using a special technique.
Specimen processing and ovarian injection requires about 45-60 min to complete for PRP and around 2.5 hours for EnPLAF. As noted above, it is almost always performed without anesthesia. The goal of treatment with PRP and with EnPLAF is to improve (“rejuvenate”) ovarian function primarily by fostering the development of more high quality oocytes. When this succeeds, your hormonal profile will change and additional follicles will appear to be developing in ovaries previously considered dormant.
Any patient that is concerned that she will do In Vitro Fertilization (IVF) and not have enough eggs or will have eggs that are not high quality should consider Ovarian Rejuvenation (OR). A recent scientific study we published indicates that OR may also be useful for women that do not have fertility concerns. Look below to learn much more about that.
As noted above, at G5F we offer two options for Ovarian Rejuvenation. One is “Platelet Rich Plasma (PRP)” and the other is a related procedure called “EnPLAF,” which is designed to further increase the concentration of growth factors you will receive from your activated platelets.
We offer activated PRP and EnPLAF as an extension of the original clinical trial. Although not all patients respond, our goal is to modify ovarian function to enable a subsequent successful IVF (oocyte retrieval) using the patient’s own eggs. After the ovarian PRP procedure is completed, periodic blood testing will be done to monitor a variety of hormones that reflect ovarian function. These blood tests do not need to be done at this clinic and can be completed at specified intervals at a commercial laboratory near the patient’s home. Some women respond very quickly, while for others, the response is delayed. If a beneficial effect is achieved, it could require approximately three months after ovarian PRP for this to be observed. Because another unknown is the expected duration of ovarian ‘rejuvenation’ following this procedure, we encourage patients with a satisfactory response to undergo IVF (either with us or elsewhere) with minimal delay once an improvement is seen. For patients seeking this procedure for non-reproductive reasons, early results have also been encouraging.
In February 2018, a procedure known as ENPLAF (Enriched/Enhanced Platelet Activating Factors) became available for those who did not respond to standard PRP treatment. As with ovarian PRP, ENPLAF has an established record of safe clinical use in other medical fields; here it is being used for a reproductive application: infertility. With ENPLAF, the ultrasound guided ovarian injection technique is identical to PRP. But what’s inserted into ovarian tissue is very highly enriched (and platelet-free) autologous growth factors instead. Studies indicate that the concentration of growth factors is approximately 10-15 times higher than with PRP alone. Working with associates at Neokine, G5F is currently the only reproductive medicine unit in USA studying this approach to modify ovarian responsiveness as a precursor to IVF. Although this intervention was initially developed as a higher-potency secondary treatment reserved for “PRP failures,” some patients have requested ENPLAF as their first-line therapy.
Both EnPLAF and PRP treatment involves carefully inserting cytokines, chemokines, and other growth factors into ovarian tissue. These can be thought of as molecular signals which activate cell growth, angiogenesis (blood vessel growth), and improved blood flow. These changes are thought to improve oocyte number and quality.
At G5F, we have already published findings describing improvements in ovarian function after insertion of PRP — a result which could have occurred for at least two reasons. One possibility is that the oocytes (eggs) we recovered within several weeks of treatment were really just there all along, but simply awakened from “sleep” by our intervention. Another explanation is that the growth factors from platelets communicated with ovarian stem cells to provide the proper setting to build new eggs.
More information about the scientific basis for these procedures is given at the bottom of this page.
Both EnPLAF and PRP can be completed here in less than one day. Because EnPLAF requires platelet incubation, this procedure does take longer than standard PRP. Our EnPLAF patients arrive in the morning, have their platelet sample obtained (by blood draw), then return in a few hours for their procedure. Our nursing team will inform all patients about when to return for the remainder of the treatment.
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