Ovarian rejuvenation is a procedure that may create new eggs in the ovaries of women who are unable to conceive because of early menopause, advanced maternal age or low oocyte (egg) reserve, yet who wish to have their own biological child.
These individuals are either unable or unwilling, for their own personal reasons, to use donor eggs or to adopt a child. New eggs do not develop in the ovaries under normal circumstances, and, according to the current scientific understanding of ovarian physiology, a woman is born with all the eggs that will be available for conception during her reproductive life. Furthermore, it is a scientifically undisputed fact that a woman’s supply of eggs diminishes both in number and genetic quality as she ages. The process of ovarian rejuvenation involves two steps. The first is the preparation of your PRP. This begins with at the insertion of a needle into your vein in order to obtain several tubes of your blood. Your white blood cells and platelets are separated from the red blood cells and serum by a procedure called centrifugation. The next part of the ovarian rejuvenation process is the injection of the PRP into the ovaries. This method had and has good results. However, it does not seem to have the same results in all patients. It is probable that due to the method of intravaginal infusion under ultra sound monitoring, PRP FORTE 4th Generation, does not manage to reach the ovarian stroma. This happens in cases where the ovaries are atrophic (premature menopause) and therefore are very small or when the ovaries are out of position as in the case with patients with a history of endometriosis. In these cases, Dr. Garavelas, propose the Laparoscopy PRP, the surest method of ovarian rejuvenation with excellent results. Laparoscopy, being a surgical procedure, involves a small incision, requires general anesthesia and longer operating. The idea behind this method, that Dr. Garavelas developed, is that the ovary is initially prepared and exposed with appropriate incisions, which allow the PRP to accurately reach the ovarian circulation. The incisions cause local activation of growth factors that prepares the ground for the PRP receptor. A combination of PRP Forte II 4th generation increase reproductive potentiality in patients who are poor responders. Tissue regeneration has been achieved in aged mice by young blood administration. Moreover, optimization of ovarian reserve biomarkers has been correlated with the presence of stem cell secreted factors in plasma from poor responder women (PR), undergoing autologous stem cell ovarian transplant, after granulocyte colony stimulating factor (GCSF) mobilization.
The success of a treatment in assisted reproductive technique (ART) cycles depends on the perfect synchrony between embryonic development and endometrial receptivity. The implantation process requires endometrial growth and differentiation of endometrial stromal cells. Human endometrium contains growth factors, receptors for growth factors, cytokines, and other key factors for correct embryonic and endometrial development. Multiple embryos fail to implant, and a relevant percentage of IVF/ICSI treatment failures are due to endometrial receptivity disorders. The granulocyte colony stimulating factor (G-CSF) and Platelet-rich Plasma (PRP) are among these new therapeutic approaches for recurrent implantation failure and in patients who are poor responders. In our experience, our approach is less invasive, safer, and has a shorter, more comfortable recovery, with an extremely low complication rate. The benefit of this procedure is the possibility of achieving pregnancy with one’s own eggs, which had not been possible prior to this procedure. The risks of this procedure are minimal, the possible side effects are pain after the procedure, which usually resolves in 1-2 hours with pain medication.
WHAT IS G-CSF?
G-CSF is a glycoprotein that stimulates the bone marrow to produce granulocytes and stem cells and release them into the bloodstream associated with cell proliferation and differentiation,
produced by reproductive tissue cells. Also promotes endometrial immunomodulation and optimizes the interaction between the embryo and the endometrium. Studies have shown that its use is associated with higher pregnancy rates and lower miscarriage rates.
Who are candidates for this procedure?
Any woman who is in good physical health and falls into one or more of the four patient categories.
In women who do not get periods, the procedure can be performed at any time. In women who do get periods, either regularly or irregularly, the procedure is best performed during the menstrual period or early in the cycle, prior to the development of an egg follicle. The procedure can be performed as early as we can because we want time to have a pick – up before the surgery. Prior to undergoing the procedure, you must not eat or drink anything for a period of 8 hours prior to the procedure, since an anesthetic is used. On the day of the procedure your blood will be drawn for the preparation of your PRP. The
anesthesiologist will insert an intravenous line and you will be an asleep while the procedure is performed. After the procedure you will sleep for 1-2 hours, at which time you will be ready for discharge, to be accompanied by a family member or friend to escort you to your home or to your hotel. Occasionally, ovarian pain will be experienced after the procedure, which will be treated with pain medications and will resolve 99% of the time within 1-2 hours.
The follow up procedure
In order to monitor if the procedure has regenerated new eggs in your ovaries, AMH (antiMullerian hormone), FSH, LH and Estradiol levels are measured at monthly intervals in women who do not menstruate, and during the menstrual flow in menstruating women for a period of six months. If the AMH levels rise, while the FSH, LH, and estradiol levels become lower, there is objective evidence of ovarian rejuvenation is demonstrated.
The follow up blood studies can be performed in our Clinic or at your local Quest Laboratory blood drawing station. Participants are required in each case to report any change in menstrual cycle or to recover spontaneously in the event of menopause.
Any possible signs or evidence that pregnancy has occurred must be reported to us immediately. In those participants in the New York City vicinity, we will monitor any early pregnancies. For those women living in distant areas or abroad, we will provide instructions and advice concerning follow up, early pregnancy monitoring and care. It is important to remember that any therapeutic effect of Growth Factors may take 3-6 months to be observed, since the any type of tissue transformation will not be immediately obvious.
Even if ovarian rejuvenation is observed, pregnancy may not necessarily occur, since there may be other factors that could interfere with physical conception.
If there is evidence of oocyte rejuvenation, the patency of the Fallopian tubes should be confirmed, and the male partner reevaluated with a semen tests as well as a postoperative examination. If these tests show that natural conception is unlikely, we will recommend appropriate treatment.
Dr. Garavelas uses this method of Laparoscopic Ovarian Rejuvenation long time with very good results, achieving so far healthy pregnancies.
The cost of Laparoscopic ovarian rejuvenation via PRP application is 3,150.00 Euros. The total cost includes the preparation of Laparoscopic PRP, the injection procedure, the operative room facility where intra-ovarian injection is performed with the patient under general sedation, anesthesiologist’s fee, anesthesia medication cost and nursing service fee.
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