Female infertility is recognized by the World Health Organization as a global health issue. Since 2005, over one million cycles of invitro fertilization are being performed globally each year.
There are many causes for the increasing number of these procedures. Ovarian exhaustion is a natural part of the aging process. Women have a limited number of eggs for fertilization. However, it is not the number of eggs that is causing this epidemic but the overall delay in the age of contraception.
In the UK alone over the past 50 years, the mean age at which women have their first child has increased from 23.8 years to 30.7 years.
Again, in the UK, the average age of IVF has been 35 for the past 20 years.
In the US, approximately 12.7% of reproductive women seek treatment for infertility each year.
Infertility is defined as the failure to achieve pregnancy after 12 months of regular unprotected sex. Approximately 85% of infertile couples have an identifiable cause.
Who Should be Evaluated with Infertility?
85% of infertile couples have an identifiable abnormality in normal physiology or underlying disease. The most common cause are ovulatory dysfunction, male factors and tubal disease. 15% of cases have an unexplained cause.
A. Women who have not conceived after 12 months of unprotected sex should be offered an evaluation
B. Women older than 35 who have not conceived in 6 moths should be evaluated
C. Immediate evaluation for women greater than 40
D. Male partners with known or suspected infertility should be evaluated
E. Women with oligomenorrhea or amenorrhea
F. Women with known uterine, tubal or peritoneal disease such as endometriosis
Fertility Testing
Ovulation Testing- This can be done at home. Testing is evaluating the surge in luteinizing hormone that occurs before ovulation. Also, an increase in progesterone can also document ovulation.
Hysterosalpingography- This test is done by injecting contrast into the fallopian tubes. This will evaluate the patency of the tubes.
Ovarian Reserve- Eggs are evaluated for quantity and quality. Women over 35 can have a depleted egg supply
Imaging testing- Pelvic ultrasound for other diseases such as fallopian tube disease or pelvic abnormalities
Hormone testing- Pituitary hormones and thyroid hormones are important in ovulation
Laparoscopic exam- This is a surgical procedure to visually examine the tubes and pelvic areas identifying endometriosis, scarring, blockages, problems with the ovaries and uterus
Treatment
Medications are given to stimulate ovulation. These drugs stimulate ovulation like natural hormones.
A. Clomiphene- this drug causes the pituitary to release follicle stimulating hormone and luteinizing hormone. These two hormones cause the growth of an ovarian follicle
B. Gonadotropins- These are injected drugs to stimulate the ovary to produce multiple eggs
C. Letrozole- This drug is in a class of aromatase inhibitors. This causes the pituitary gland to release more FSH and LH and causes growth of the follicle
D. Metformin- Used when insulin resistance is known and helps to improve the use of insulin especially women with PCOS. (Polycystic ovarian syndrome)
E. Bromocriptine- This drug is a dopamine agonist. This drug is used when an excess of prolactin is present.
Side effects of these medications are many. They can cause multiple pregnancies, hyperstimulation syndrome of the ovaries with side effects including painful ovaries, abdominal pain, edema vomiting and diarrhea, and an increased risk of ovarian tumors in the future.
Reproductive Assistance Procedures
A. Laparoscopic surgery to correct abnormal anatomy causing the infertility problem. This can include opening blocked fallopian tubes or removing fibroids and adhesions.
B. Intrauterine insemination- This procedures places healthy sperm in the uterus at the time of ovulation
C. Reproductive assistive technology- This procedure is when eggs are harvested and then cultured outside the body in the lab and then transferring the embryo back into the uterus. This is called invitro fertilization or IVF.
Since the advent of clinical IVF in 1978, Assisted Reproductive Techniques were expanded in the same period. It has made infertility treatable in many cases. However, such techniques are limited due to the reliance on a healthy oocyte for the fertilization. Also, ART do little to address the fundamental dysfunction within an ovary that leads to infertility because of an exhausted ovary.
Investigation has found oogonial stem cells in the ovarian cortex. Stimulation of these stem cells in sub fertile women would lead to spontaneous oogenesis. In laboratory experiments with mice, these stem cells were removed from aged atrophic ovaries and implanted in young
mice, this resulted in spontaneous oogenesis. This experiment proved given the proper environment, aged ovarian stem cells would be rejuvenated and possible function properly. This would give improved egg quality.
Platelet Rich Plasma, since its introduction in 1954, has been applied in a wide range of medical applications. Recent studies have shown the use of PRP has significant benefits in many reproductive conditions. PRP has improved the reproductive outcomes in patients with refractory endometrium, repeated implantation failures and primary ovarian insufficiency.
PRP contains many growth factors, cytokines and bioactive proteins. The proliferative and cell differentiation effects seen with these growth factors and cytokines contained in PRP are thought to be the underlying effects of PRP in reproductive medicine.
In infertility, PRP treatment of the ovaries enhances ovarian regeneration by promoting follicle formation, angiogenesis, proliferation and differentiation, thereby improving reproductive outcomes.
Studies
Global Reproductive Health 2022 Jan 7:e59
Introduction: To evaluate the effects of intraovarian platelet rich plasma instillation in young Indian women with diminished ovarian reserve
Conclusion: This is an ongoing study which has demonstrated the potential of IOPRP instillation
Intraovarian Injection of Platelet Rich Plasma in Assisted Reproduction: Too Much Too Soon?
Hum Reprod 2021 Jul; 36(7): 1737-1750
Introduction: In this article, we summarize some of the physiological details of PRP and reviewing the existing emerging literature on ovarian insufficiency as well as the mechanism by which PRP acts on the ovary.
Conclusion: There are encouraging data supporting the notion that PRP treatment might have some future in the benefits of assisted reproductive therapy.
J Assist Reprod Genet 2021 May;38(5): 1003-1012 PMID 33723748
Purpose: Platelet Rich plasma is now starting to become an area of interest in reproductive medicine. The aim of this article is to review the existing literature on the effects of autologous PRP in reproductive medicine, focusing on infertility, poor ovarian reserve, menopause, premature ovarian failure and thin endometrium.
Conclusions: Limited literature shows promise in increasing endometrial thickness, increasing hormone levels, as well as increasing chemical and clinical pregnancy rates.
J Assist Reprod Genet 2020 Apr;37(4); 855-863 PMID 32030554
Purpose: To investigate the impact of a 3-month course of intracortical injections of autologous platelet rich plasma upon ovarian reserve markers versus no intervention in women with low ovarian reserve prior to undergoing assisted reproductive technology (ART)
Conclusion: PRP injections are effective and safe to improve markers of low ovarian reserve prior to ART
Juventix Regenerative Medical is an industry leader in the regenerative medical field. Our Platelet Rich Plasma Kits are FDA cleared and designed for safety, sterility and effectiveness. Our kits have been scientifically manufactured to provide a consistent platelet concentrate, devoid of red blood cells with a minimum number of leukocytes, critical to the regenerative process.
Juventix Regenerative Medical offers a patent pending LED Activator to activate the platelets and begin the regenerative process. The activation is a critical step in the release of cytokines, growth factors and bioactive proteins and is accomplished with LED light. This negates the use of chemical additives such as Calcium Chloride, Thrombin or Collagen.
Juventix Regenerative Medical supplies a Bio Incubator that transforms the Platelet Rich Plasma into an Injectable Platelet Rich Fibrin. The Platelet Rich Fibrin, commonly called the “second generation of platelet products” has different growth factors and cytokines than the original PRP. These different cytokines provide a broader range of clinical applications due to their anti-inflammatory properties.
Juventix Regenerative Medical offers many more products and services for the regenerative professional. Our newest collaboration is with Evolutionary Biologics who supply exosomes and other cellular regenerative products.
RESTORE, REVIVE, REGENERATE- JEVENTIX REGENERATIVE MEDICAL
Regenerative Regards,
Dr. Robert McGrath
