Naturally a woman is born with the fixed number of eggs she will need during her reproductive years (12- 45 years). By birth she usually has about 500,000 to 700,000 immature eggs. She loses about half of this naturally, by the time she gets her first period and be-comes biologically fertile. There after she will continue to remove about ten eggs every month but with only one or two maturing to be released for possible fertilization and hence pregnancy. If no fertilization occurs these eggs are lost in the month and she then gets her period (menstruation),the cycle continues over and over again.

The best quality of eggs are usually produced within the ages of 20 to 35 years. There after the quality of the eggs reduce and (POI). In many of these women the cause of the POI/POF/PMP some cycles may even occur with-out the woman releasing any eggs. By the age of 50 a woman usually reaches menopause and the eggs practically get finished. However, it has been found out that actually the ovaries can be rejuvenated to pro-duce some more young eggs cells that have been redundant since birth, thus awakening up the egg and hormone production.

In some other women, the ovaries may stop producing eggs and hormones at a younger age (less than 40 years), a condition called premature menopause (PMM) or premature ovarian failure (POF)How do the eggs of a woman form? The life Cycle of a woman’s egg may not be known .

Ovarian rejuvenation therapy (ORT) is a form of fertility treat-ment that is aimed at reviving the functions of an aging or failing ovary in a woman. It is suitable for women with diminished ovarian reserve (DOR) due to menopause or Premature Ovarian Failure (POF) – also called Premature Menopause (PMM) or Premature Ovarian insufficiency (POI).

Diminished Ovarian reserve (DOR) is a common challenge in the treatment of infertility. This condition is characterized by reduced quality and number of eggs and low levels of Ovarian hormones. It is known to affect 3-4 of every 10 women attending fertility treatment in many IVF Clinics.

We see the same burden at Bethany fertility Centre. DOR may be attributed to natural meno-pause if the woman is above 40 years of age, or it may result from premature menopause, premature ovarian failure(POF) if the woman is under 40 years of age.

DOR may not show any obvious signs/ symptoms especially if the process has just set in. However, the following may be the clue to DOR;

1. Irregular/ unpre dictable periods. Your periods may delay or sometimes the periods may come earlier than expected causing your menstrual cycles to become longer or shorter than usual.
2. Missing periods. If you miss your periods for two or more consecutive months DOR could be the cause.
3. Feeling of hot flashes and dry skin may be attributed to DOR
4. Reduced Vaginal secretions especially around the mid cycle and/or during sexual intercourse may be caused by DOR.
5. Reduced sexual desired, arousal and painful sex could be caused by DOR. You may stop feeling ovulation signs like mid-cycle pain, raised body temperatures etc if you have DOR.
6. Recurrent miscarriages may also be caused by DOR.
7. Failure to conceive (infertility) could be a result of DOR9. Repeated IVF/IUI failure may be caused by DOR10. Reduced Ovarian hormones (E2, Progesterone, AMH) are often results of DOR.
8. Reduced egg count (antral follicular count- AFC) on vaginal ultrasound may indicate under lying DOR.

How does DOR impact your fertility treatment? DOR may have significant effects on your fertility treatment;

1. It may reduce your chances of conceiving through IVF.
2. It may cause your doctors to increase the dose of the fertility drugs you may need or the duration of the treatment and therefore the total cost of your fertility treatment.
3. Increase your chance of using donor eggs for IVF.

Numerous attempts have been made and are still being made to revive ovarian function in women with DOR. These have traditionally included;

1. Use of Dehydroepiandrosterone (DHEA).
2. Nutritional supplements (mainly multivitamins).
3. Use of steroid hormones like predinisolone, hydrocortisone etc
4. Growth hormone injections:These attempts have continued to yield conflicting results among the clients and hence more options are still needed to manage DOR. Platelet rich plasma (PRP) is one of the new/ novel modalities that are being introduced in the treatment of DOR. PRP has for long been used in other fields of medicine like orthopaedics, aesthetics and sports medicine to promote tissue regeneration and healing. Recently, based on this logic PRP is now being used in reproductive medicine to revive ovarian function in therapy called ovarian rejuvenation treatment. These initial attempts of ovarian rejuvenation with PRP have been reported to be successful and promising. Some spontaneous and IVFpregnancies have already been recorded in some centres. PRP is reported to be very safe and effective. About 2/3 of the women treated in some of the pioneering centres in USA and UK regained satisfactory ovarian function. Being at the fore front of reproductive health care, our team at Bethany women and Family Hospital would like to take the pleasure and opportunity to introduce this novel mode of therapy to our clients with DOR.

PRP stands for platelet rich plasma. This is a fraction of blood that contains high concentration (>X5) of platelets. It is prepared in the laboratory from the patient’s own blood. During ORT with PRP, 1-2 mls of freshly prepared PRP is injected into each of the patient’s ovaries.

The injection procedure is done under trans-vaginal ultrasound guidance, just like in egg collection procedure of IVF. The patient is put under light sedation during this procedure.The platelets when injected into the ovary will get activated and release the growth factors that in-turn activate the ovary to recruit more egg cells and other cells that help the ovary to produce hormones.

First, the required amount of blood (15- 20mls) will be drawn from the woman’s veins into a special sterile tube. The blood is then centrifuged in a temperature controlled pre-programed special centrifuge to separate the blood components. The PRP is then extracted and made ready for injection.

How is the PRP used for ORT?

Like in egg retrieval procedure, PRP-ORT is done under light anaesthesia (sedation) using a trans-vaginal ultrasound guidance. Using special needle, the required dose of the prepared PRP is injected into each ovary. The patient is followed up regularly to assess the response.

How do I prepare for PRP?

Before you undergo PRP therapy for Ovarian rejuvenation you should ensure that;

1. You fully understand this procedure including any possible complications
2. You give an informed consent for the PRP-ORT.
3. You have discussed other options and any other procedures/ treatments that may follow after P R P.

Before PRP-ORT the woman needs to undergo the following tests;

1. Full haem-gram
2. Anti-mullerian Hormone (AMH) level
3. FSH/LH4. Estradiol (E2)
4. Antral Follicular count (AFC).

Also note that some of these tests will be repeated during the course of treatment to monitor your response to PRP-ORT.For a woman preparing for fertility treatment semen analysis needs to be done for her male partner before PRP

Although PRP-ORT is generally safe, some relatively minor complications may arise. These may include;

1. Bleeding from injection sites in the vagina
2. Infections
3. Complications related to anaesthesia