A reproductive revolution

If you are a woman struggling to conceive naturally or fear hitting menopause without any kids, all is not lost. Take the case of a Greek lawyer (40), who was diagnosed with congenital ovarian failure, and told that she couldn’t have babies anymore. However, in a dramatic turnaround, she conceived naturally, nine days after she underwent an experimental therapy which reversed her menopause. She is ecstatic and now expecting twins.

For the first time in India, a hospital has introduced Platelet-rich Plasma (PRP), a recent technique that can enable a woman to have babies even after menopause or with conditions like congenital ovarian failure. What’s more, the treatment has been successful and is on the rise. Dr Manjula Anagani, M.D., consultant gynaecologist, obstetrician and laparoscopic surgeon, shares more details about the treatment.

What is PRP all about?
PRP is blood plasma that is enriched with platelets. As a concentrated source of autologous platelets, it contains several growth factors and other cytokines that can stimulate healing of ovarian soft tissue (growth cells). This therapy utilises growth factors present in alpha granules of platelets in an autologous manner to generate new, younger tissue and blood vessels. The PRP can be directly injected into the endometrium and stimulates cellular processes that aid in endometrial regeneration.

Parameters and recommendations
We conduct a follicle-stimulating hormone blood test and based on the parameters, we proceed to the treatment. There are two types of treatments:

PRP in endometrium — It aims to determine the change in endometrial lining thickness, blood flow to zone-3 of the endometrium in patients with Asherman’s Syndrome, rate of return or normalisation of menses, chances of spontaneous pregnancy, embryo transfer and clinical pregnancy rate. This treatment is recommended for women with persistent thin lining < 6 mm in previous IVF or FET cycles, moderate-to-severe Asherman’s syndrome and severe oligomenorrhea.

PRP in ovaries — The PRP is injected into the ovarian stroma or into the blood supply that comes to the ovary. It primarily aims at resumption of menses and improvement in hormonal levels toward normal ranges. The analysis is determined by a positive pregnancy test. This is recommended for women with primary or secondary amenorrhea for at least three months and infertile women more than 35 years of age having low ovarian reserve and low anti-mullerian hormone levels.

Description
Between the seventh and 11th day of the menstrual cycle, 20 ml of venous blood is drawn from the patient and centrifuged immediately to obtain 2 ml of PRP. Hysteroscopy is then done to see the endometrial cavity, endometrium adhesions or any other diseases. PRP is infused into the uterine cavity immediately with an IUI catheter (2 ml). For ovarian instillation, 20-40 ml of venous blood is drawn to obtain 2-4 ml of PRP. Laparoscopy is done to see if the patient is suffering from uterus, tubes, ovaries, adhesions or any other diseases.

Assessment
Endometrial thickness is measured at the thickest part of the longitudinal axis of the uterus. Hormones such as follicle-stimulating hormone, luteinising hormone, anti-mullerian hormone are measured before and after the procedure. The steps for overall treatment would vary from three to six months, and the pregnancy results are then assessed.

How different is prp from IVF?
IVF is a procedure where you take out an egg and a sperm, make a baby and put it back into the uterus. But in PRP, there’s no egg at all, so we are using a technique to produce and stimulate the egg.

Number of cases in India
There are quite a few cases in India where women in their mid 20’s have also undergone menopause (premature ovarian failure). We are working with several patients and one woman is currently going through these tests.

Safe and cost-effective
The therapy is considered safe, cost-effective and natural because, rather than using a synthetic substance, PRP uses cells and growth factors from one’s own blood. Also, there’s no risk of transmission of blood-borne infections like hepatitis and HIV as no preservatives are used.

Results
It is not a one off miraculous success. Although good results are expected, there is no guarantee. People who have been going for surrogacy are now coming forward to try this. Through this treatment, women who have not been menstruating or have undergone premature menopause will get back to the normal menstrual cycle and have a chance at pregnancy.