Q. Can I opt for PRP injection after IVF failure?

Answered by
Dr. Sameer Kumar
and medically reviewed by Dr. Nithila A
Published on Apr 28, 2019

Hello doctor,

I had done first IVF last year, but it failed due to a bad quality egg. Embryos were not developed after two days. AMH level is 1.52, and the egg count was low. On consulting another doctor, she suggested to go with PRP injection to rejuvenate the ovary, so that egg count and quality will increase. I am afraid if PRP will cause any harm to the ovary? Are there any issues to try PRP?

Dr. Sameer Kumar

Infertility Obstetrics And Gynaecology
#

Hello,

Welcome to icliniq.com.

You have been wrongly guided by your doctor because there is no apparent need for PRP (platelet rich plasma) therapy and injection into ovaries to rejuvenate the ovaries to produce better quality eggs. The therapy modality is relatively new and not sufficient studies have been done yet on them. It is being done for women with really low antral follicular count and AMH (anti-mullerian hormone) less than one and failed two natural timed intercourse and six IUI (intrauterine insemination) and one IVF (in vitro fertilization) cycles.

You were directly subjected to IVF cycle, which was wrong without treating the pathology. AMH can be increased with DHEAS (dehydroepiandrosterone) therapy which is oral supplementation along with low dose OC pill (oral contraceptive) therapy for two months. That improves the quality and also the chances of natural conception.

Also, another concern is a bicornuate uterus, which has their own demerits for natural conception so that IUI can be offered for conception at least for six cycles, post-therapy. If succeeded, then the bicornuate uterus is unable to sustain the pregnancy for the complete term, and often preterm labor occurs giving birth to a preterm baby. So weigh this complication as well in your mind. You can either opt for Strassman's operation first to increase the size of the uterus by joining them together and then try after a year or take the risk of IUI or IVF and accept complications associated with bicornuate uterus itself.

You have to think and make a decision. PRP is the last line of therapy, not primary, in my opinion.

Thank you doctor,

We tried natural way with supplements. After two years I tried IUI two times, did a laparoscopy to increase the space in the bicornuate uterus at that time doctor found both fallopian tubes are blocked. After that only the doctor tried IVF. Egg retrieved in two cycles five numbers at the first cycle and seven numbers in the second cycle. Processed in the lab around five in that only two fertilized but no development after two days. The doctor informed us that follicles are less and egg counts are low.

I understand that there is no guarantee that PRP will increase egg quality or quantity. But we would like to give a try. Is there any harm if we try the PRP at this stage itself? Will it affect existing egg cells? I am okay if PRP does not improve, but I am afraid if it may cause any issues. Kindly help.

Dr. Sameer Kumar

Infertility Obstetrics And Gynaecology
#

Hello,

Welcome back to icliniq.com.

Thanks for the prior history of treatment.

If tubes are blocked and Strassman's operation has been done, with a poor ovarian response to ovulation drugs, two failed IUI and then one failed IVF with two embryo transfer, then indeed I must say you have been patient and committed to the treatment.

Ideally speaking PRP therapy is offered to premature ovarian failure patients who have stopped producing eggs completely or whose follicle diameter is less than 4 mm at any time on follicular study. This is a modality to rejuvenate the ovarian tissue with autologous platelets, which release PDGF or platelet-derived growth factors, which in turn help in removing the scarred tissue and help in improving ovarian response by rejuvenation the scarred ovarian tissue. The follow-ups scans are important, and the therapeutic response may take even 12 weeks.

It is unlikely to cause any harm as the platelets are derived from your own blood and are autologous and hence there would be no rejection reaction as in blood transfusion or transplants. So, there is nothing to lose, you can surely give it a try.

I am adding some information for your perusal which shall help you understand the PRP modality better.

Platelets are very small components in their blood that generally help with clotting, but they are rich in growth factors and cytokines. These are in little granules within the platelets, and when you use platelet-rich plasma, the goal is to release these cytokines and growth factors into the tissue, which then help the tissue to regenerate. Under normal circumstances as tissue gets old, it gets replaced by fibrotic basically scar tissue. As ovaries age is they become like little clumps of scar tissue. In using platelet-rich plasma we hope that we can regenerate some of the normal ovarian tissue and not just that but regenerate vascularization, so there is an improved blood supply, and as a result hopefully restore some ovarian function.

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