Due to recent advances in fertility medicine, there is now hope for women with low ovarian reserve, poor egg quality, premature ovarian insufficiency, and even early menopause to have babies using their own eggs. In this special report, Dr. Jean Nassar, a medical doctor who has practised for more than 15 years in In-Vitro Fertilisation in France, Belgium, Lebanon, and currently in Nigeria, discusses how ovarian rejuvenation, a new fertility treatment, offers hopes of pregnancy for women nearing or experiencing early menopause. Associate Editor ADEKUNLE YUSUF
Many fertility clinics have always told women they can only get pregnant using donor eggs. This is not true anymore! There is now hope for women with low ovarian reserve, poor egg quality, premature ovarian insufficiency, and even early menopause to have babies using their own eggs – thanks to latest advances in fertility medicine. This good news for women battling infertility issues is possible through platelet-rich plasma (PRP) ovarian rejuvenation, a new fertility treatment for women nearing or experiencing menopause, since post-menopausal women carry up to 1,000 dormant eggs within their ovaries.
According to Dr. Jean Nassar, a medical doctor who has practised for more than 15 years in in-vitro fertilisation in France, Belgium, Lebanon, and currently in Nigeria, PRP is a cutting-edge regenerative therapy that utilises the body’s own blood to accelerate healing at the injection site. For decades, this method has been used for hair loss, joint injuries, dental treatment, facial rejuvenation and other conditions. As it pertains to fertility, he explained that PRP injections are given vaginally; directly into the ovaries, with the guidance of an ultrasound – a therapy typically offered alongside the more traditional in-vitro fertilisation (IVF), which has been shown to improve egg quality and quantity, and increase the thickness of the uterine lining, thus improving endometrial receptivity and the chance of pregnancy.
Because the success of fertility treatment often hinges on the number and quality of oocytes (developing eggs), medics explain that this poses an enormous challenge in women with diminished ovarian reserve. Despite the development of modern IVF techniques that have overcome male infertility factors, options for women with oocyte issues are limited to either doing repetitive treatments or resorting to donor oocytes. While poor numbers and quality of the oocytes is mostly associated with advancing age, fertility experts add that it may also affect younger women, with one per cent of women of reproductive age estimated to have severe decrease in ovarian reserve, thereby contributing to intractable infertility.
What ovarian rejuvenation means and its potential benefits for women
Ovarian rejuvenation is the latest technique that aims to improve the function of the ovaries in women by injecting platelet-rich plasma PRP (PRP) into the ovaries. “The procedure involves extracting blood from the patient; that’s why it is a safe procedure. The blood is processed in a centrifuge machine to separate the platelet-rich plasma from the other components of the blood. Platelets contain various growth factors that stimulate the growth and development of ovarian follicles, potentially improving ovarian function,” Dr Nassar said.
The concept behind ovarian rejuvenation is to stimulate follicle growth by stimulating growth of dormant follicles in the ovary and promoting the development of new eggs. Adding to that, by injecting PRP in ovaries, it promotes the formation of new blood vessels; so it improves the overall function of the ovaries, including hormone production and ovulatory capacity. On other hand, the growth factors present in PRP improve the quality of oocytes by promoting their maturation and reducing oxidative stress. This, in turn, may increase the chances of successful fertilisation spontaneously or by in-vitro fertilisation.
Who are the ideal candidates for ovarian rejuvenation and how it is performed?
Since the goal of PRP is to improve fertility and restore ovarian function, every woman who has decreased ovarian reserve based on her age or she is experiencing early menopause is an ideal candidate for ovarian PRP, Dr Nassar,a renowned fertility specialist at One Wellness Centre, Lagos, said. Also, those who have experienced recurrent failed IVF cycles because of reduced quality eggs are ideal candidates for ovarian rejuvenation.
Doctors said PRP, being a blood-derived product characterised by high concentrations of growth factors and chemokines that are known to be beneficial in the healing process, is produced by centrifuging a small quantity of the patient’s own blood and extracting the active, platelet-rich fraction, which is then introduced to the human body typically by injection. For long, PRP is said to have been quite useful for therapeutic purposes in different medical areas, ranging from orthopedics to plastic surgery, for its putative ability to stimulate and facilitate cell proliferation and thereby tissue differentiation and regeneration.
But in the context of reproductive medicine, PRP has been proposed to increase pregnancy rates after uterine flushing in women with recurrent implantation failure or thin endometrium. Intra-ovarian injection of PRP has also been proposed to activate dormant ovarian follicles pre-IVF-treatment in cases of idiopathic low ovarian reserve, premature ovarian insufficiency or ovarian depletion because of advanced maternal age.
“Based on consultation with a specialist, he will decide if she is a candidate of ovarian PRP. This procedure is done under light anesthesia so the patient will be asked to stay fasting at the same day of procedure. Her blood will be collected. This blood sample will be processed with a specific protocol to separate the platelets and growth factors from other components resulting in a concentrated PRP solution. Using ultrasound guidance, a thin needle is inserted into the ovarian tissue. The concentrated PRP solution is then slowly injected into the ovaries. The ultrasound helps guide the needle to the precise location within the ovaries.”
Success rate and side effects associated with ovarian rejuvenation
Since ovarian PRP is performed using the patient’s own blood, experts said no side effects are linked to it because it is considered a safe procedure. The only side effect that might be experienced for some women is discomfort at the injection site; it will typically resolve within 48 hours. Pain killer is advised to be taken in this case. “Ovarian rejuvenation and in-vitro fertilisation (IVF) are two distinct fertility treatments with two different methods aiming for a same goal: achieving pregnancy. Ovarian rejuvenation is still a new technique under studies that aims to improve ovarian function; it might be done for trying to achieve pregnancy spontaneously or by IVF. It is case by case decision. In-vitro Fertilization (IVF) is a widely used assisted reproductive technology that involves fertilizing eggs and sperm in the laboratory subsequently transferring embryos inside the uterus.
“The success rates of ovarian rejuvenation are still being evaluated, and the evidence is limited. The effectiveness of the treatment in improving fertility outcomes is not yet well-established because this technique is still newly practised in the ovarian tissue. But, up till now, it has promising results even in my own practice here in Nigeria. It is important to shed light on its safety for the patient even if it is still under research because it is performed with the patient’s own blood,” he said.
While fertility doctors insist that ovarian rejuvenation doesn’t generally have an age limit, it is important to know that the response to treatment is based on the patient’s age. “So, it is better to be performed up to 50 years old patients after evaluating the patient of course. And to be honest, I will not recommend it for a patient after 50; I would rather recommend egg donation, which would be a better option in this case.”
Nowadays, different treatments are available for infertility, depending on the case and mainly the reason(s) behind infertility. First, Dr Nassar, who is also the Head of the IVF unit at St. Georges Hospital University Medical Centre in Lebanon, advised that the couple should consult a specialist, after doing all the tests required, who will advise the treatment suitable for the couple. For example, intracytoplasmic sperm injection (ICSI) is the most used technique worldwide; it is based on injecting one competent sperm inside the cytoplasm of the egg and, by that, the fertilisation is being pushed to occur. Other than ICSI, there are a lot of treatments available like classical IVF, intrauterine insemination IUI, gamete donation, surrogacy, cryopreservation and pre-genetic diagnosis (PGD).
Acceptability of ovarian rejuvenation globally and in Nigeria
Definitely, it is acceptable and especially here in Nigeria. I realised during my practice here that couples seek help for infertility issues after 40s. Subsequently, ovarian PRP could be one of the treatments advised by the doctor due to its safety for the patient and it is a minimally-invasive procedure; the patient can continue her daily activities directly. In addition, the couple can try to conceive spontaneously in the meantime while doing PRP sessions.
A healthy lifestyle helps improve egg quality and by that, I mean normal BMI, exercise frequently, avoiding smoking and alcohol and reduce stress. On top of that, the patient will be advised to take some specific vitamins to help us improve the quality of eggs. The goal of ovarian rejuvenation is achieving pregnancy. In some cases, patients achieved their pregnancy spontaneously right after ovarian PRP. In other cases, it might be done in parallel with an IVF/ICSI. In this case, ovarian PRP improves the quantity and the quality of the eggs, and ICSI will be done subsequently.
Specific factors that may affect the success of ovarian rejuvenation
While ovarian PRP is still under investigation, several factors may potentially affect its success. Generally, younger women have a higher chance to get better results. Of course, this procedure should be performed by a skilled professional physician who has a deep understanding of the procedure and its intricacies are more likely to achieve better outcomes. On top of that each woman’s response can be highly individual. Factors such as genetic predisposition, hormonal balance, and the specific condition being addressed may vary among individuals, impacting the success of the procedure.
At the same day of ovarian PRP, the patient will be monitored in the recovery room until she is fully awake. After that, she will be advised to come for a follow up scan after four to six weeks after the PRP session. Based on her response and her plan, the physician will recommend a second session or not. This could be done up to three sessions. Every procedure at One Wellness Centre should start with a consultation with the physician and especially Ovarian rejuvenation. The patient must come for a consultation first. Based on her history, age, hormonal status, ultrasound and her intension, a tailored plan will be recommended after discussion with the specialist.
Words of encouragement for couples battling infertility
“For those who are still battling with infertility, I want to tell them that infertility can be a difficult journey but remember that miracles do happen. The first step to make your dream come true is by seeking help as earlier as possible. Maintain honest communication with your doctor. Share your feelings, fears, and hopes so he can help you to be on the right track.
“If conventional methods haven’t provided the desired results, consider exploring alternative paths to parenthood. Options such as adoption, surrogacy, or fertility treatments like IVF may offer alternative paths to starting or expanding your family. Remember, you are not alone. Every journey is unique, and there is no one-size-fits-all solution. Stay positive and be patient; you can overcome the challenges and achieve your dreams.”
