UNDERSTANDING Ovarian PRP
▫️WRITTEN BY DR RAELIA LEW
WHAT IS OVARIAN PRP? (PLATELET RICH PLASMA)
PRP ( Platelet Rich Plasma ) is an extract of your own blood that contains a high concentration of platelets, growth factors, and bio-active proteins essential for tissue regeneration and healing. Physicians have extensive experience applying PRP therapies to accelerate surgical healing; repair tendon, ligament and joint damage; heal skin wounds; and help regrow muscle and bone.
The same physiological process that aids tissue regeneration and healing in other areas of the body may improve ovarian function.
Ovarian PRP Therapy is a procedure that involves extracting PRP from the patient’s own blood and injecting PRP into the ovaries. This can be achieved at the time of a laparoscopy or at an IVF egg collection procedure under anaesthetic.
The ambition of PRP therapy is to improve egg quality and egg quantity in women with low egg reserves, with the overarching goal of improving a woman’s chance of becoming pregnant. The use of PRP within the uterine cavity to improve the thickness of the endometrial lining, or to improve implantation (intrauterine PRP) is a mainstream, evidence-based therapy and no longer considered experimental.
The Ovarian PRP procedure is relatively safe and low risk. However, this procedure can carry risks of developing an infection or a chance of ovarian bleeding.
IS PRP GUARANTEED TO IMPROVE OVARIAN RESERVE?
Research has demonstrated that PRP intra-ovarian injection may assist some patients who have diminished ovarian reserve or who are in premature ovarian failure, to improve the general ovarian tissue health so that the dormant primordial follicles can be ‘activated’ to commence development into follicles that may release an egg for fertilisation – either naturally or via IVF methods. In-vitro research has shown that shown that PRP can help promote the development of primordial and primary follicles to the pre-antral stage. There is no guarantee that the potential improvement in follicle development will result in follicles developing an oocyte for fertilisation, a successful implantation or live birth.
HOW IS PRP PREPARED?
30mls of the patient’s blood is collected in the same way as a standard blood test. Using a special separating device, Alocuro PRO-PRP, and a centrifuge, the platelets are separated from the whole blood and are collected in 3ml of plasma. This small volume of plasma with a high platelet concentration is known as Platelet-Rich Plasma (PRP). Using this TGA approved technology it is possible to extract a very ‘pure’ PRP sample with over 90% platelet collection efficiency, so that maximum growth factors can be introduced to the ovaries.
HOW IS PRP ADMINISTERED?
You will arrive at the hospital at your scheduled admission time.
To ensure you experience no discomfort you should discuss pain management options with your anaesthetic specialist at your consultation prior to the procedure.
The Ovarian PRP procedure will take approximately 20-30 minutes. Your CREI WHM Fertility Specialist will determine the best method for injection.
TRANSVAGINAL: PRP will be injected transvaginal directly into the ovaries via an ultrasound guided technique. This is feasible at the time of an IVF egg collection procedure for patients whose ovaries are easy to visualise and safely reach via a transvaginal approach.
LAPAROSCOPY: Ovarian PRP can be injected concurrently with other surgeries, such as during a diagnostic laparoscopy or laparoscopy for the management of endometriosis or other known pelvic pathology. Post your procedure you will be taken to recovery to be monitored for approximately one (1) hour.
Due to the anaesthetic used to sedate you for the procedure, we advise you to be accompanied by someone upon your discharge from hospital.
ARE THERE ANY SIDE EFFECTS WITH OVARIAN PRP?
Major complications from the PRP injection are extremely rare as the material being injected consists of your own plasma, platelets, growth factors and an extremely small amount of anti-coagulant, which is used during the spinning of the blood in the centrifuge.
For the venepuncture to collect the blood sample - when a needle is inserted into the body there is always a potential risk of injury to a muscle, blood vessel or nerve. Minor complications of the venepuncture blood collection can include local bleeding / bruising / tenderness/ subtle swelling at the blood collection site. All usual precautions to minimise complications and infection will be followed. Other potential complications - From the procedure generally, patients may experience dizziness or fainting –simply from the anxiety associated with the procedure / blood collection etc.
PRP intra-ovarian injection technique – Your specialist will determine the best technique to inject the PRP into the ovaries for each patient, and the risks involved with the technique (OPU/Laparoscopy) will be carefully explained, and consent discussed and documented on a separate form.
All usual precautions to minimize complications and infection will be followed.
If you should experience significant pain, swelling or local infection symptoms you should contact Women’s Health Melbourne on 03 9041 9082 during business hours or please present to the Emergency Department if after-hours.
OVARIAN PRP– PRE-PROCEDURE PREPARATION
Please inform our staff prior to the day of the PRP procedure if currently you have any of the following, as we may not be able to perform your PRP procedure:
Platelet disorders and blood disorders
Acute or Chronic Infections (eg: urinary tract infection)
Severe systemic or metabolic conditions/ disorders
Anti‐coagulation therapy
Use of oral corticosteroids within ten days prior to PRP procedure
If any of the above applies to you currently, please discuss with our staff.
To maximise the potential healing effect from the PRP we recommend the following guidelines:
Please seek advice from your Fertility Specialist prior to ceasing any medication for your PRP procedure
2 weeks before the procedure:
Cease oral corticosteroids (eg prednisone) for 2 weeks prior to the procedure.
1 week before the procedure:
Do not take any over the counter blood thinning medications such as aspirin.
Prescribed anticoagulants such as clexane and warfarin should not be ceased without individualised advice – please ensure this has been discusssed with your fertility specialist and an indivividualised risk management plan has been made in consultation with your haematologist. Supplements that are known to increase bruising should also be ceased – Garlic, Ginko, Ginseng, Green Tea, Vitamin E, Multi-vitamins, Omega 3,6 and fish oils.
Day of procedure
Last meal to be low-fat please
Shower prior to procedure
You will need to fast for 6-8 hours prior to anaesthetic (no food or fluid).
Drink at least one litre of water prior to commencing your pre-operative fasting to prevent dehydration. Only light activities for the first 24 hours post procedure – eg: no running, gym, swimming etc
OVARIAN PRP– POST PROCEDURE
PRP’s growth factors improve tissue regeneration by stimulating the body’s normal healing response to an injury. However, as the growth factors are highly concentrated, the regenerative response and biological activity is amplified, which can create local symptoms for the first 24 hours. There may be a feeling of subtle uterine fullness, throbbing, warmth. Minimal spotting may occur for the first 24 hours, so wearing a liner is recommended.
TO MAXIMISE HEALING BENEFIT FROM THE OVARIAN PRP THERAPY WE RECOMMEND:
For 12 hours after the PRP procedure
Not to wash the area with anything but water nor apply any products
For 24 hours after the PRP procedure
Nil intercourse.
Nil exercise that would create excessive perspiration for 24 hours
For 48 hours after the PRP procedure
No spas or swimming pools.
Minimal alcohol, coffee, caffeine; and nil supplements that may increase bruising
For patients who regularly take aspirin, you may resume it 48 hours after the procedure, unless otherwise directed by your Fertility Specialist
For 7 days after the PRP procedure
If you require pain relief, please use Panadol or Panadeine preferentially (dose as usual for you)
Although the chance of an infection caused by the PRP procedure is extremely rare, please contact WHM if you experience progressive symptoms after 24 hours, or fever, during business hours on 03 9041 9082 or you may wish to seek review by your GP, or local Emergency Department if after-hours.
Written by Dr Raelia Lew
Dr Raelia Lew is the Medical Director of Women’s Health Melbourne. Dr Raelia is a Royal Australia and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) Board Certified CREI Fertility Specialist, and is President Elect of the Australia and New Zealand Society of Reproductive Endocrinologists and Infertility Specialists(ANZSREI).