Ovarian PRP and ‘rejuvenation’ of the ovaries: what the studies really say

Patients regularly ask me if they can ‘have the PRP treatment’ during their stay, often after reading an enthusiastic testimonial. I am not a doctor and I do not decide on treatments. But I can give you an honest overview of the current state of knowledge, so that you can ask the right questions.

The principle

Blood is drawn, centrifuged to concentrate the platelets, and then this platelet-rich plasma (PRP) is injected into the ovaries, vaginally under ultrasound guidance, using a technique similar to egg retrieval. The idea is that the growth factors contained in the platelets could ‘reawaken’ dormant follicles or improve the ovarian environment.

PRP has long been used in sports medicine and dermatology. Its application to the ovaries is recent: the first published case series date from around 2016, and several Greek teams were among the pioneers.

Who is it offered to

• Women with a very low ovarian reserve or poor responders.
• Women with premature ovarian insufficiency.
• Women in perimenopause wishing to attempt IVF using their own eggs.

What the studies show

The majority of publications are case series or studies without a control group. They sometimes report an increase in AMH, a return of menstruation or a few pregnancies. The problem is that, in the absence of a comparison, it is not known what would have happened without PRP: AMH levels fluctuate spontaneously, and women with premature ovarian insufficiency have a low probability of spontaneous pregnancy, in the region of 5 to 10 per cent over the course of their lives.

The few randomised trials that have been published are small in scale and yield conflicting results: some find a slight improvement in the number of eggs in poor responders, others find nothing significant, and none has robustly demonstrated an increase in the live birth rate.

The position of professional bodies

In its 2023 recommendations on IVF add-ons, ESHRE states that ovarian and intra-uterine PRP is not recommended outside a research setting. The reason is not that it is dangerous, but that its efficacy has not been demonstrated and that the protocols (preparation, dose, number of injections) are not standardised.

Risks

These are the risks of an ovarian puncture: pain, bleeding and infection, though these are rare. As PRP is prepared from your own blood, there is no risk of rejection. The main risk lies elsewhere: time. For a 43-year-old woman, waiting three to six months to see if the PRP ‘works’ comes at a real biological cost.

The cost

In Greece, published prices generally range from a few hundred to over a thousand euros per session, with several sessions sometimes required. It is never reimbursed. Ask for a written quote and details of what it includes.

If you are considering PRP

1. Ask for the clinic’s results for women of your age and with your AMH levels: how many births, out of how many patients?
2. Ask whether the treatment is carried out as part of a research protocol, with specific informed consent.
3. Set yourself a time limit before considering another option.
4. Discuss it with a doctor who has no interest in performing the procedure.

My opinion as a coordinator

I fully understand the hope that PRP represents for a woman who is not ready to consider egg donation. If you choose to give it a go, do so in full knowledge of the facts, with a defined budget and timetable. And bear in mind that donation, should it become necessary, does not negate anything you have tried: it is another way of becoming a mother, not a failure. I discuss this in the article on IVF after the age of 43.

Frequently asked questions