Platelet-Rich Plasma (PRP) for Ovarian Rejuvenation
New report of PRP use requires cautious interpretation
Elsewhere in this issue of the VOICE we report on the IRB approval of CHR’s PRP study for the purpose of Ovarian Rejuvenation in women with POF/POI. We also in last month’s VOICE noted that PRP has been in clinical use in Europe and in a number of centers in the U.S., though without any published evidence of success.
Now comes a paper, published by European and U.S. investigators (Sills et al., First data on in vitro fertilization ad blastocyst formation after intraovarian injection of calcium gluconate-activated autologous platelet rich plasma. Gynecol Endocrinol 2018;28:1-5), which does report on 4 cases of intra-ovarian injection of PRP. Unfortunately, however, like the study on the use of bone marrow stem cells, this report makes little sense.
Again, there are multiple reasons for this conclusion: First, the study involves only 4 women and none of them really suffered from POF/POI. They all, indeed, did demonstrate abnormally low age-specific ovarian reserve but were far from being in menopause. In other words, they are what we here at CHR describe as women with premature ovarian aging (POA) or occult primary ovarian insufficiency (oPOI). Women with POA/oPOI in our opinion do not require Ovarian Rejuvenation and will, even with much less invasive treatments, produce in most cases good egg and embryo numbers. Without appropriate controls, it, therefore, appears very likely that these 4 patients would have had similar IVF cycle outcomes even without PRP treatments.
Even more strange appears to us, however, the claim of the authors that 5mL of PRP were injected into each ovary in those patients. How that is technically even possible, is unclear, considering that, especially in older women, most ovaries have a much smaller total volume than 5mL. Just to place this point into context, CHR is planning to inject 0.5mL into each ovary. In other words, not a very credible study, and CHR’s study remains much needed!
This is a part of the April 2018 CHR VOICE.
Norbert Gleicher, MD, FACOG, FACS
Norbert Gleicher, MD, leads CHR’s clinical and research efforts as Medical Director and Chief Scientist. A world-renowned specialist in reproductive endocrinology, Dr. Gleicher has published hundreds of peer-reviewed papers and lectured globally while keeping an active clinical career focused on ovarian aging, immunological issues and other difficult cases of infertility.
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