OVARIAN REJUVENATION - ROLE OF PLATELET RICH PLASMA THERAPY BY DR SHASHWAT JANI

1. Ovarian Rejuvenation
( Role Of PRP )
Dr Shashwat Jani
M.S. ( OBS - GYN ), F.I.A.O.G.
Diploma in Advanced Endoscopy.
Assistant Professor, Sheth V. S. General hospital.
Smt. N.H.L. Municipal Medical College, Ahmedabad.
Mobile : +91 99099 44160.
E- mail : drshashwatjani@gmail.com
104-Dec-18

2. Rejuvenate
To make something more effective,
modern and successful by using new
ideas and methods.

3. Ovarian
Rejuvenation
(a brighter side towards all lost hopes)
A procedure intended
to re-awake egg
maturation and
development within
the ovary by
activating dormant
follicles.
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4. Process by which the
production of eggs is
artificially stimulated,
giving women the
chance to produce more
eggs than they would
naturally have been able
to, and therefore giving
them the chance to
conceive using their own
genetic material .
Helping patient to
conceive.
Ovarian
Rejuvenation
(A Brighter Side Towards
All Lost Hopes)
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5. Back to basics . . .
 Women are born with about 2 million eggs.
 About 11,000 of them are lost EVERY MONTH prior
to puberty.
 At puberty she is left with about 400,000 eggs.
 After this, every month a woman continues to lose
about 1000 eggs.
 This loss is irrespective of medicines, oral
contraceptives, pregnancy, health issues, nutritional
status etc.
 The number of eggs a woman is born with will
determine at what rate she loses her eggs.
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6. • Over the last 20 years or so, we are finding
rapid decline in the ovarian reserve.
• More and more women are suffering from
poor ovarian reserve (POR) at an earlier age.
• This could be a result of environmental
pollution, toxic substances or fertilizers in our
food or maybe the stressful situations we live in.
• Whatever maybe the reason, the fact
remains that fertility is going down rapidly.
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7. Indications
Menopausal or Perimenopausal women <50 years.
Infertile women , over the age of 35 years having
low egg reserve and low AMH levels.
Women <35yrs with low egg reserve and low AMH
levels.
Women with premature ovarian failure
Primary ovarian Insufficiency
Loss of ovarian function due to chemotherapy
Ovarian dysfunction
04-Dec-18
Dr Shashwat Jani.
+91 99099 44160.
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8. Platelet Rich Plasma ( PRP )
• The theory behind this modality of treatment
was derived from natural healing process as
the body's first response to tissue injury is to
deliver platelets to the injured area.
• Platelets promote healing and attract stem
cells to the site of injury.
04-Dec-18
Dr Shashwat Jani.
+91 99099 44160.
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9. • Autologous PRP is derived from whole
blood of the same individual centrifuged
to remove RBCs.
• The remaining plasma has a higher
concentration of growth factors 5-10
folds greater than whole blood. Cocktail
of growth factors.
04-Dec-18
Dr Shashwat Jani.
+91 99099 44160.
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10. PRP Preparation
04-Dec-18
Dr Shashwat Jani.
+91 99099 44160.
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11. Preparation of PRP is an office
procedure that involves withdrawal of
blood, preparation of the PRP, and then
injection into diseased area by the
following steps:
04-Dec-18
Dr Shashwat Jani.
+91 99099 44160.
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12. PRP Classification
• Types of PRP preparations
1. After centrifugation of whole blood,
2. Four preparations can be obtained.
3. These types or classifications were proposed
by Ehrenfest et al. (2009), depending on
their cell content and fibrin density
04-Dec-18
Dr Shashwat Jani.
+91 99099 44160.
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13. Ehrenfest et al. (2009) Classification
04-Dec-18
Dr Shashwat Jani.
+91 99099 44160.
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14. PRP Composition
04-Dec-18
Dr Shashwat Jani.
+91 99099 44160.
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15. Procedure
PRP is extracted using a specially designed
centrifuge machine and a special conical tube.
About 15 ml of venous blood is taken from the
patient, injected into the conical tube and
centrifuged. (21-24degree Celsius ) @1200 rpm
for 12 minutes
Blood separates in 3 layers :
1. Upper : platelets and WBC
2. middle buffy coat (rich in WBC)
3. lower: RBCs. Dr Shashwat Jani.
+91 99099 44160.
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Dr Shashwat Jani.
+91 99099 44160.
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17. • The upper and intermediate Buffy layers are
transferred to an empty sterile tube.
• The plasma is centrifuged again @ 3300 rpm
for 7 min to help in formation of soft pellets at
the bottom of the tube.
• Discard the upper 2/3 portions of plasma as
this volume is PPP (Platelet Poor Plasma).
• Pellets are homogenized in lower 1/3rd to
create PRP ( Platelet Rich Plasma ).
04-Dec-18
Dr Shashwat Jani.
+91 99099 44160.
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18. To Summarize
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19. Infusion Procedure
 Call the patient at the end of the periods,
before the follicles begin to grow on the empty
stomach
 Withdraw blood for PRP preparation.
30 ml of venous blood yields 3-5 ml of PRP.
 Inject PRP in both the ovaries as done for
the egg pickup under USG guidance.
 The patient can go home 1-2 hours.
04-Dec-18
Dr Shashwat Jani.
+91 99099 44160.
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20.  The process is to be repeated every
month for three months.
 In few centers , Laparoscopy done for
injection in B/L Ovaries
 If required, The PRP can be infused in
to the uterus for thin endometrial
thickening.
04-Dec-18
Dr Shashwat Jani.
+91 99099 44160.
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21. Follow Up…
• AMH , FSH, LH and Estradiol levels are
measured at monthly intervals in women who
do not menstruate, and during the menstrual
flow in menstruating women for a period of
six months.
• If the AMH levels rise,
• while the FSH, LH, and estradiol levels become
lower, there is objective evidence of ovarian
rejuvenation is demonstrated.
04-Dec-18
Dr Shashwat Jani.
+91 99099 44160.
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22. Side Effects
Very minimum......
• Pain
• Fever
• Internal bleeding
04-Dec-18
Dr Shashwat Jani.
+91 99099 44160.
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+91 99099 44160.
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+91 99099 44160.
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+91 99099 44160.
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29. Articles....
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30. Articles....
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31. Future....
Apart from ovarian rejuvenation , researches are
going into oocyte vitrification, a process which
rapidly slows the aging process in eggs.
This means that women may put off trying for a
baby for longer, without the fear of decreased
fertility and poorer quality eggs.
This is also a great option for women who need
to undergo treatments for cancer, and who now
have the chance to preserve their fertility.

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Dr Shashwat Jani.
+91 99099 44160.
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