Ovarian Rejuvenation (PRP)

CAG & Ovarian PRP – Background information

PRP01CAG is the first IVF clinic in the United States to focus on therapeutic and research applications for platelet enriched plasma (PRP) and the human ovary. We offer this as a continuation of the original PRP protocol pioneered in Greece [1]. It is a safe but relatively new elective procedure which puts platelet-derived growth factors inside the ovaries and near potential eggs. This is achieved by injection under direct ultrasound guidance. If ovarian stem cells are present, then these could also be recruited to develop into eggs—thus reducing reliance on donor oocytes for IVF.

Specimen processing and ovarian injection requires about 45-60min to complete here, and is performed without anesthesia. The goal of ovarian PRP is to improve (“rejuvenate”) ovarian function and foster development of oocytes. When this succeeds, the hormonal profile changes and additional eggs appear to be developing in ovaries previously considered dormant.

E. Scott Sills, MD PhD is the Principal Investigator for the only registered “ovarian rejuvenation” human research study in the United States, as listed with ClinicalTrials.gov [2]. To date, Dr. Sills has completed more than 100 ovarian PRP procedures at CAG using an established methodology with precision laboratory support from RegenLab (Lausanne) [3]. Because ovarian PRP entails use of the patient’s own (autologous) tissue rather than donor platelets, there is no risk of cell rejection or graft-versus-host reaction. The procedure is generally well tolerated and there have been no adverse events, complications, or hospitalizations associated with PRP as performed by Dr. Sills.

 

What is the scientific basis of PRP?

For over a century, the accepted paradigm of the “biological clock” has shaped the understanding of how the ovary changes over time. Because of ovarian senescence (aging), new oocytes do not develop in the ovaries and a woman will have an endowment of all the eggs she will ever have on the day she is born. We also know that a woman’s supply of eggs (ovarian reserve [4]) diminishes with time—this results in a decline in both number and genetic quality of oocytes as she grows older.

PRP02The human ovary is covered by an epithelial monolayer which undergoes cyclic rupture and tissue repair with each ovulation. This represents considerable wear and tear on the ovary. While resident stem cells are presumed to be crucial for the regeneration needed for hemostasis and repair, the identity and mode of action for this remains incompletely characterized. Although recent research has advanced the understanding of ovarian stem cell biology, clinical applications are still being developed. The work performed at CAG is generating original data on this important topic.

Use of PRP is perhaps best known for as a remedy for low platelets to improve hemostasis. But PRP also emits soluble mediators which orchestrate immune responses and tissue regeneration. Closely associated with inflammation and its many mediators, PRP figures prominently in wound repair and coordinates a complex regulatory interplay of cellular migration, extracellular matrix remodeling, cell proliferation, apoptosis, differentiation, and angiogenesis. This means signal transmissions from PRP are substantial and these factors are known to influence neighboring cells.

Notwithstanding the now well-established surgical role of PRP in wound healing and tissue repair, clinical data have suggested that platelets can contribute to overall organ function as well. Because the main problem in many cases of infertility is ovarian senescence and a presumably unstoppable decline in the oocyte endowment, it seems plausible to consider PRP in a reproductive context to address this challenge. Particularly since the concept of lost ovarian reserve as inexorably linked to organ (ovarian) failure is being challenged by current research here and elsewhere, the possibility of PRP improving the ovarian microenvironment, and even interacting with putative ovarian germline stem cells (GSC), warrants consideration.

 

What is the goal of ovarian PRP?

This is an investigational procedure which ideally will modify ovarian performance after PRP application, with a view to enable subsequent IVF (oocyte retrieval) using native eggs. In other words, ovarian PRP is designed to improve female fertility. After the ovarian PRP procedure at CAG, periodic blood testing will be done to monitor a variety of parameters expected to give insight regarding ovarian function. These blood tests do not need to be done at CAG, and can be completed at specified intervals at a commercial laboratory near the patient’s home. If a beneficial effect occurs, it may require approximately three months after ovarian PRP for this to be observed. We still do not know if there are any clinical characteristics or laboratory factors which may help predict which patients are more likely to respond to ovarian PRP. Because another unknown is the expected duration of ovarian ‘rejuvenation’ following this procedure, we encourage patients with a satisfactory response to undergo IVF (either here or elsewhere) with minimal delay.

 

Is it possible to have more than one ovarian PRP attempt?

Yes. Although limited data exist to answer this question specifically, a small number of CAG patients have undergone a second ovarian PRP treatment without difficulty. In general, these patients are older and may require more than one “dose” to achieve a satisfactory response.

 

OK, I’m interested…what do I need to do next?

If you’ve read this far, you probably already know more than most people do about ovarian PRP. Nevertheless, you may still have some questions about the procedure. The first step is to contact the study administrators directly by accessing this LINK [5]. No PRP patients are enrolled directly at CAG, so you must first register with the research managers to begin the process. Only after patients receive clearance from Inovium, Inc. are specific appointments at CAG possible to be booked.

Read More
[1] the original PRP protocal pioneered in Greece
[2] Dr. Sills is the Principal Investigator as listed with ClinicalTrials.gov
[3] RegenLab (Lausanne)
[4] about ovarian reserve
[5] contact Inovium Rejuventation to enroll in CAG PRP Program in the US

Copyright © 2015 CAG.All rights reserved.
E. Scott Sills, MD PhD and the Center for Advanced Genetics (CAG) is a reproductive medicine clinic located in Carlsbad, California USA, in North San Diego County, and serves the cities of Carlsbad, Oceanside, Vista, San Marcos, Encinitas, Escondido, Fallbrook, Bonsall, and Camp Pendleton. The fertility clinic specializes in in-vitro fertilization (IVF), frozen embryo transfer (FET), blastocyst transfer, pre-implantation genetic diagnosis/screening/testing of embryos (PGD, PGS) for possible genetic abnormalities and gender selection, Next Generation Sequencing (NGS), intra-uterine insemination (IUI), surrogacy, donor cycles, male-factor infertility, Essure® removal, treatment for recurrent pregnancy loss, and fertility preservation (egg freezing, sperm banking). Dr. Sills is published over 100 times in peer-reviewed publications and just published his book “Fighting at the Fertility Front,” a book that covers infertility, treatments, and issues that are unique to military personnel. CAG is committed to building families, including assisting those of the LGBT community. We offer low-interest fertility treatment financing to make having a baby a reality for virtually everyone.
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