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Platelet-Rich Plasma (PRP) Treatment for Ovarian Rejuvenation: Does it Work?
Platelet-Rich Plasma (PRP) treatments for premature ovarian aging are increasingly being offered to patients who may not understand the lack of research behind it. Dr. Gleicher explains the existing scientific literature behind PRP and CHR's new study.Want to Consult Dr. Gleicher?
You have been hearing from us in recent weeks and months a lot about PRP (platelet rich plasma). You have been hearing about it because we were preparing and we finally got approval for a clinical trial of PRP in women with early menopause. When we made the point that we wanted to do a study, one of the primary motivations was that a number of centers--starting in Europe, but now also in the US including in New York and in California-- have started offering this treatment to patients without really any reported clinical success-- not even experiences. In other words, Yes, there are claims that PRP injections into ovaries "rejuvenate" those ovaries and produce fresh follicles, but beyond those claims there have been no data and this has been obviously a frequent topic here at our Center and in our communications with you--our patients and our friends. We do not believe in treatments that don't have evidence in support and so it is quite troubling to us that this concept seems to be gaining considerable popularity. It's been offered at sometimes ridiculous prices to a really innocent patient population that does not know what to believe. And that was a big motivation why we decided to initiate the study because one way or the other we are as much interested in finding out whether the PRP works in rejuvenating ovaries as many of you may be. Now since we made this point that there are really no studies, once that it was indeed published very recently (just two weeks ago) in a European Journal. And in that study, the authors claimed that PRP indeed "rejuvenated" ovaries in four patients in whom they tried of the injections. But a word of caution is indicated here because first of all, four cases don't mean anything. Much larger numbers are required and for example, the study that that we just started here at CHR-- based on statistical analysis-- requires us to have at least roughly 40 patients. But even more importantly, those four patients that these authors reported really did not have early menopause. They did not suffer from premature ovarian failure (also called primary ovarian insufficiency). They were patients who suffered from what we here at CHR call POA (premature ovarian aging). Yes, they had slightly elevated FSH levels. Yes, they had somewhat low AMH levels. Yes, they had infertility that had failed getting pregnant with some treatments, but we see such patients at CHR every single day over and over again and by god they don't know if they don't need this treatment. Particularly at younger ages, these patients have fantastic pregnancy rates just if one treats them appropriately. So not only was this paper that was recently published underpowered (that's the medical term when not enough patients are studied), but also the patient selection was really not what initially has been promised by PRP--namely the treatment of patients in menopause. So that's the second point, but probably the most bizarre and final point why we couldn't take this manuscript very seriously was the claim that they injected 5 ml of PRP into each ovary. Think about that-- 5 ml! That's a huge amount of fluid volume into those little ovaries. I really don't know how they do that technically, so either and that was a mistake and what they really meant to say is maybe .5 ml because that's the amount that we are injecting in our clinical trial, but whatever it is. Either it is not believable because nobody can inject 5 ml of fluid into one ovary, or the author's simply didn't proofread their own paper very well. So once again, a point of caution-- PRP may work, it may not work. We promise you we will find out here at CHR. It shouldn't take us too long because it shouldn't take us too long to recruit for the real patients with premature ovarian failure into such a study. Whatever the outcome, we will tell you, but as we said before, anybody who tells you right now that PRP really works, really ask them for the evidence. Thank you.
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