Ovarian Rejuvenation
Rejuvenating the ovaries for increasing their egg-producing capacity is called “Ovarian Rejuvenation”.
Ovarian function is the most crucial part of IVF treatment. Good ovarian function, more healthy eggs, more chance of good quality embryos, more chance of embryo selection and more chances of freezing the extra embryos.
Unfortunately, some women have ovaries that start losing their function earlier than expected. Some women try to conceive at a later age; here, there is a naturally expected decline in the functional capacity of ovaries. Some women want to conceive with their own eggs even after they have achieved menopause, where ovaries have already stopped producing eggs.
Patients with very low AMH and increasing FSH reports, patients who have a poor response to IVF are good candidates for ovarian rejuvenation.
Normally an aggressive stimulation protocol is tried to get maximum eggs per treatment cycle. However, it requires a very high dose of drugs, more expense, and still a very poor yield of eggs.
A more logical solution is to increase the functioning capacity of ovaries. Isn’t it?
PRP – Platelet Rich Plasma therapy
Platelets are very rich in cytokines and many other growth-promoting factors. Activation and enrichment of platelets make them even more capable functionally. Injection of concentrated, activated, enriched PRP can enhance the egg-producing capacity of the ovaries.
BFI has achieved many natural pregnancies also in these very poor pregnancy chance couples.
We can expect ovaries to be more responsive to natural or outside stimuli. It can be expected to get a better response in IVF stimulation as well.
PROCEDURE
- The procedure is very simple and safe.
- The blood is collected from the patient.
- It is processed in our own laboratory to separate platelets.
Special treatment is done to enrich the preparation and make it more effective.
The prepared PRP is injected in both ovaries in ultrasound guidance with a very thin needle.
ADVANTAGES
It is prepared from the patients own blood, so no outside drug or material is injected into the body. It is a very simple & relatively inexpensive process. The effect can last for a long time, not only for one treatment cycle.
DISADVANTAGES AND LIMITATIONS
- It is not a sure shot procedure. The result is variable in different patients.
- It is not a permanent cure.
- The beneficial effect reduces over a period of time.
Stem cell Therapy
Stem cells are the patients’ own cells that have the capacity to transform themselves into different body cells. They are also used for ovarian rejuvenation.
ADVANTAGES
Most commonly, stem cells are derived from patients own body, so there is no risk of transmission of infection. The procedure is relatively very safe. Effective in many cases.
DISADVANTAGES AND LIMITATIONS
Stem cell harvesting is a more invasive process. It is more expensive than PRP. Whether it has better results compared to simpler options like PRP is not proven. Results are variable; all treated patients may not have improvement.
PROCEDURE
Most procedures use stem cells derived from bone marrow, which is collected from the hip bone. Prepared stem cells are injected into the ovaries.
Drug therapy
Androgen substitutes
Egg development cycle is for approximately 3 months. Of this development of first two months is under control of androgens. Androgens are considered to be predominantly male hormones, but their function in female egg development is also crucial. Various such medicines or nutritional supplements are tried. None of this shows good results when the medical studies are well designed. One such drug is testosterone gel applied to the skin. However, it requires medical supervision. The more popular supplement is DHEA.
DHEA (Dehydroepiandrosterone)
DHEA is found in many foods naturally. Adrenal glands also secrete it. DHEA is given for 3 to 6 months with the hope to increase androgen level in the ovary. After the therapy, ovaries are expected to have more egg number. Our take is that it shows only marginal benefit if any; you should not delay your treatment for DHEA, as delay may do more harm than good.
Nutritional supplements
Various foods and supplements with anti-ageing- antioxidant properties are used. Common are Coenzyme Q10 (ubiquinone/ubiquinone), Vitamin D, folic acid etc.
The percentage of patients who benefit from medical treatment is low.
The major disadvantage is time wasted in waiting for improvement, which may not occur but may reduce fertility – ovarian reserve.
The best policy is to various methods of ovarian rejuvenation along with immediate IVF, in our opinion. Avoid wasting any time.
Conclusion
There is no sure shot therapy to improve ovarian function or egg-producing capacity of the ovaries. Any attempt to improve it has limited success. Who will benefit and who will not is not predictable
Time spent for treatment v/s deterioration due to delay in treatment must be kept in mind. A final call should be taken by the patient and the treating doctor.
Ahmedabad