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Ovarian Rejuvenation

Ovarian Rejuvenation therapy is a new, experimental procedure which for the first time offers some hope for women who suffer from an early premature ovarian failure, which is a lack of eggs within the ovary necessary to support a normal menstrual cycle.

While men continue to produce sperm throughout their lives a woman’s entire egg production occurs before she is born, from whence the number in the ovary gradually declines in a constant and largely predictable fashion, resulting in menopause at around 51 years of age. If this process of decline is accelerated, or the ovary damaged by illness or surgery, the ovary will run out of eggs and menopause will develop at an earlier age. It has always been believed that no new egg cells could be made by women.

First reported by a fertility specialist from Greece at a European fertility conference in 2017[i] , there have been a subsequent series of case reports in the medical literature of the successful regeneration of eggs in women by the injection of growth factors directly into the ovary which are thought to activate egg precursor cells.

The growth factors are released from activated platelets, which are extracted from the patient who is to be treated. This fluid is finding a wide range of applications in other fields of Medicine and is used in sports medicine, orthopaedics, dentistry and plastic surgery[ii] to accelerate healing, repair tendon injuries, to treat chronic pain and re-grow hair, among other indications.

Ovarian Rejuvenation involves injecting the growth factors in to the ovary using a technique similar to that used to extract eggs for IVF.

What do we know about this treatment?

  1. Some women, who have been previously diagnosed as menopausal or too close to menopause to attempt IVF, have subsequently either been able to undergo IVF or have gone on to have natural pregnancies.
  2. It has enabled some women to have a pregnancy with their own eggs in situations where it was thought eggs from a donor was the only option.
  3. Treatment success may be seen by a return of periods where they previously had stopped, a reduction in FSH levels may be seen in menopausal women and a rise in AMH levels which is hoped will be associated with a return of ovarian function and ovarian eggs.

What don’t we know about this treatment?

  1. Where are the eggs coming from, though there is evidence that suggest these are new eggs made from oocyte precursor cells in the ovary[iii].
  2. As there are no randomised trials using ovarian rejuvenation therapy the strength of the effect and the likelihood of success or failure in unknown. A small randomised pilot study comparing IVF outcomes in women with a proven poor ovarian reserve in their 40s was published in late 2019[iv]. It reported a trend towards benefit that was not statistically significant in treated patients, a 35% no response rate in the treated group and a 7% spontaneous pregnancy rate in treated patients.
  3. How long the improvement will last for. It does appear to be a temporary improvement lasting in the order of 6 months.
  4. Intra-ovarian injections for ovarian rejuvenation appears to be a very safe procedure, with no reported harm occurring as a result of having it done. Unfortunately though, as very few treatments have been done, the short and long term risks must be regarded as unknown and the procedure must be regarded as experimental. We will be closely monitoring any side effects as part of the study.

Reference:

[i] Pantos K, Nitsos N, Kokkali G, et al. Ovarian rejuvenation and folliculogenesis reactivation in perimenopausal women after autologous platelet-rich plasma treatment. Hum Reprod. 2016; (Suppl. 1): i301

[ii] Schmitz JP, Hollinger JO. The biology of platelet-rich plasma. J Oral maxillofac Surg. 2001; 59:1119-121. https://doi.org/10.1053/joms.2001.26801

[iii] Sills ES, Rickers NS, Li X & Palermo GD. First data on in vitro fertilization and blastocyst formation after intraovarian injection of calcium gluconate-activated autologous platelet rich plasma, Gynecological Endocrinology 2018; 34 (9). https://doi.org/10.1080/09513590.2018.1445219

[iv] Stojkovska S, Dimitrov G, Stamenkovska N, Hadzi-Lega M, & Petanovski Z. (2019). Live Birth Rates in Poor Responders’ Group after Previous Treatment with Autologous Platelet-Rich Plasma and Low Dose Ovarian Stimulation Compared with Poor Responders Used Only Low Dose Ovarian Stimulation Before in Vitro Fertilization. Open Access Macedonian Journal of Medical Sciences, 7 (19), 3184-3188. https://doi.org/10.3889/oamjms.2019.825.