Plasma Rich in Platelets: learn about fertility techniques – 07/03/2023 – Health

In 2020, following fertility treatment at the Genesis Clinic in Athens, Greece, a woman who had been through menopause for over a year gave birth to a child. In the same year, Brazilian Suzana Gomes, then 52 years old, also gave birth to her long-awaited son, even though she had already had five surgeries to remove fibroids from the endometrium, the wall of the uterus.

Common in both cases is the use of the PRP (Platelet-Rich Plasma) technique, a platelet concentrate that is extracted from the woman’s own blood and injected into the ovaries or endometrium to treat infertility.

This procedure is already common in the world in other specialties, such as orthopedic, dental, dermatological surgeries and even for aesthetic purposes. However, its use in the treatment of infertility is recent and became better known after research carried out by a group of Greek doctors that showed promising results in the treatment of ovarian insufficiency with the use of PRP.

The study was carried out between 2017 and 2019 with 120 previously selected women, divided into four groups of 30: patients with poor ovarian response (POR), premature ovarian failure (POI), pre-menopause and menopause. A significant improvement in the hormonal profile and in the ovarian reserve was observed in relation to the POR participants. Of the 30, 12 had healthy children at the end of the process.

Recovery of menses was observed in 18 out of 30 patients with IOP, and only 3 managed to get pregnant and have children. Similarly, 13 of 30 menopausal women responded positively to PRP treatment, but only one gave birth to a child. Lastly, menstrual regularity and improved hormone levels were reported for 24 out of 30 premenopausal women. Of these, four became pregnant, but only three children were born alive.

The results were inconsistent, but they drew the attention of specialists around the world due to the perspective of success in cases that until then were almost impossible to succeed. One of these is Suzana Gomes, now 56 years old — her son, Rafael, is 3.

She says that after having performed five surgeries in ten years to remove fibroids from the endometrium, doctors said she would never get pregnant. Even so, she and her husband, Fernando, decided to try every possible technique. After two failed attempts, the couple was already thinking about giving up when they were informed about PRP by doctor Fernando Prado, a specialist in human reproduction and clinical director of Neo Vita.

“It was the last attempt after three years of trying, two of which were unsuccessful. After a lot of medication, my uterus was not able to grow any more to place the embryos. In the last attempt, the doctor spoke about the procedure and that it was not used as much because it was new and never I had done it in utero. Thank God it worked, I had my baby”, says Gomes.

After the treatment, with little hope, she found out she was pregnant on October 19, 2019. “To this day I look at my son and think it’s a miracle. The feeling is inexplicable.”

Fernando Prado states that PRP improves the quality of the endometrium in women who are trying to get pregnant, especially in those in which this tissue does not grow, even with hormonal stimuli.

“In addition to PRP helping to increase the thickness of the endometrium, it can improve vascularity and tissue regeneration, as well as stimulate the release of growth factors that help with embryo implantation. It is also useful in cases of women who have had a lot of surgery in the uterus, such as to remove fibroids, polyps or synechiae [cicatrizes]”, says the expert.

Although this technique has shown good results, it is still in the experimental research phase. According to Anvisa (National Health Surveillance Agency) and CFM (Federal Council of Medicine), PRP cannot be marketed or used as advertising by clinics as a standard procedure.

“Carrying out procedures on an experimental basis implies that they will follow specific norms for scientific research with human beings, which is under the supervision of the CEP/Conep system (Committees for Ethics in Research/National Commission for Ethics in Research). performs the procedure cannot charge and still assumes a series of commitments with the research subject (note that he is not a patient), including medical and assistance support in case of a bad evolution”, highlights the CFM, in a note.

According to Anvisa, in Brazil PRP can be used as a therapeutic treatment only in dentistry.

Obstetrician Álvaro Pigatto Ceschin, specialist in reproduction at the Feliccità clinic, in Curitiba (PR), and president of Sbra (Brazilian Association of Assisted Reproduction), points to a controversy related to PRP. Some clinics, in Brazil and abroad, advertise the procedure as “ovarian rejuvenation”, which he dismisses.

“They call it rejuvenation of the ovary, but you are not doing rejuvenation from the point of view of creating new eggs, you are going to activate the dormant eggs that are in the ovary”, he says.

He explains that the menopausal woman still has about 10,000 inactive eggs. So, the injection of PRP into the ovary is to try to activate the remaining follicles, which would allow them to be used in a possible pregnancy.

How the treatment is done

Ovarian or endometrial PRP treatment is usually performed in a clinic or doctor’s office, and involves the following steps:

1. Blood collection: A blood sample is taken from the patient. This sample is then processed in a centrifuge, separating platelets, which are heavier than other blood cells. Thus, the amount of platelets in the same volume of plasma will become higher, resulting in PRP
2. Preparation: Platelet Rich Plasma is prepared and concentrated in a syringe, in a volume of 0.5 ml to 1 ml, to be injected at the desired location
3. Injection: The PRP is then injected directly into the ovary or the endometrium, depending on the treatment chosen. “When it is done in the endometrium, we use a catheter like the one used for intrauterine insemination. It is a painless procedure and does not require anesthesia. To inject the ovaries, the patient needs to be anesthetized and in a surgical environment. It is done as if it were an egg collection. for in vitro fertilization, using the same needle we use to capture the eggs, but injecting the PRP into the ovaries”, says doctor Fernando Prado.

Note: The number and frequency of PRP treatment sessions are not fully defined and may vary depending on the needs and conditions of each patient, explains the specialist.