Ovarian Reboot

If a scientist wanted to find a dependable pack of cellular growth signals, not synthesized in a lab or by drug companies but made organically by the patient herself—which could then be used to awaken the adult ovary—then platelet rich plasma (PRP) would be a good place to look first. This is because PRP already has been used effectively to treat other tissue disorders. We know it is safe. PRP is comprised of molecules which coordinate cellular repair after tissue injury. Closely linked to the same signals involved when tissue is inflamed, PRP figures prominently in regenerating tissue, cell proliferation, extracellular matrix remodeling, shutting off certain cells by “programmed cell death”, differentiation, and growing new blood vessels. Think of platelets as a type of biological envelope, and this sealed packet is crammed full of letters (cell signals) which, when opened and read by the target (ovary), messages get delivered instructing the nearby cells to do specific things. Now consider what happens each month on the ovary surface, when a mature egg pops out at ovulation. Even though we take it for granted, there is actually considerable wear and tear on the ovary every time its lining gets a tiny hole in it. How does the ovary fix that surface spot where ovulation just happened? It’s already known that PRP plays a role in the local tissue repair response following ovarian epithelial microtrauma after ovulation, and it probably helps with overall ovary function too. But the effects of PRP and its associated growth factors in the ovaries were not given much thought until lately. How could this be explored more carefully? In 2017, a study was launched here to look at this issue. There was a suspicion that PRP was doing something to the ovary, and even before patient enrollment closed, there were reports suggesting that intraovarian application of PRP could lift ovarian reserve, allow eggs to be collected, and even build embryos. In the meantime, early results from similar PRP techniques started to show up in peer-review medical journals. The registered clinical trial gathered lab data from 182 women who completed ovarian PRP and then underwent monitoring. While serum FSH, E2, and AMH were all checked over time, the latter was classified as the primary marker of ovarian reserve, given the relative consistency of AMH throughout the menstrual cycle. The average age for the females in this group was just over 45, and most had already failed IVF before. Some had already stopped having menstrual cycles anyway, so serum AMH is preferred in this setting where there is no “cycle day”...