Ovarian Rejuvenation

Understanding Ovarian Rejuvenation

Around 10 per cent of couples’ experience difficulties when trying to get pregnant. Developments in In Vitro Fertilization (IVF) technology have dramatically improved the chances of conceiving. Improvements in IVF have almost doubled live birth rates over the past 25 years, with success rates often reaching 80%-90% after 3 cycles. 

But one group of patients - the Poor Responders - has presented a major challenge to clinicians. As a woman gets older, both the number of chromosomally normal eggs that can be retrieved and the number of chromosomally normal embryos that are produced tend to decrease, resulting in reduced IVF success after age 38-40. 

If a normal embryo (with normal chromosome numbers) is obtained, it has a 50-60% chance of pregnancy in all age groups, and this is achieved with fewer eggs if you are under 30 years old. But at the age of 40, we may need more cycles to achieve many more eggs to obtain a normal embryo. 

So, we need a technique to get more and normal embryos. Many different approaches have been tried over the years, but none of them have worked very well. But now, treatment with Stem Cells and Stem Cell Products has shown very promising results.
There are reports of pregnancies occurring in patients who became post-menopausal after chemotherapy or radiotherapy and then regained menstrual cycles and even fertility after bone marrow transplantation (a rich source of stem cells). This has been attributed to stem cell factors that can reach the ovaries to restore their function.

Different sources of stem cells have been tried, but the best effect achieved from mesenchymal stem cells (MSCs) of umbilical cord.
Umbilical cord derived MSCs exosomes have also been used to improve the success rate in patients with “Poor Response in IVF”. After combined exosome and PRP infusion into the ovaries, some patients had dramatic increases in AMH levels and achieved significant improvement in antral follicle count and mature oocytes as well as good quality embryos.

Exosomes

Exosomes are tiny particles (30-150nm or 1/1000th of the size of a cell) that are secreted from stem cells and travel throughout the body, controlling the function and performance of every cell in the body like a conductor controls a symphony orchestra.

Exosomes are also involved in cell-to-cell signaling. They are important for anti-inflammatory effects, immune regulation, immunosuppression, anti-apoptosis, production of anti-fibrosis factors and suppression of oxidative stress.

Exosomes can be commercially produced from umbilical cord MSCs (since these exosomes come from young stem cells that produce at least 30% more exosomes), can be frozen and stored at -20°C for up to 6 months, which means they can be transported on dry ice, easily thawed and immediately available for use. Because they are derived from young perinatal MSCs, they contain factors that promote growth, development and differentiation, whereas adult MSCs derived from fat or bone marrow are more likely to promote anti-inflammatory or anti-tumor responses.

How Does It Work?

How MSCs can restore damaged ovarian tissue is being actively researched. MSCs, exosomes and PRP all produce growth factors that inhibit apoptosis (cell death) and stimulate growth and development.

A key component of the function of stem cells is their ability to "home in", (migrate throughout the body and gather at specific microenvironment) releasing tissue repair factors at the site of the injury or inflammation. In the ovary, MSC can differentiate into several ovarian tissue cells, which then secrete cytokines and growth factors that stimulate egg cell growth and development. MSCs injected directly into the ovaries in humans can develop into egg cells is a strong possibility.

A much more impressive response in the number of eggs and quality of embryos (30-60%) was seen when exosomes were injected into the ovaries of patients with a poor response to IVF. This improvement in the quality and quantity of embryos can increase the chances of having your own biological baby before the use of donor eggs or donor embryos. 

PRP (Platelet Rich Plasma)

PRP is a platelet-rich plasma product obtained from patients' own blood. It is rich in platelets. It also contains growth factors and substances that promote cellular healing. PRP is used to support ovarian and uterine health and increase the chance of embryo implantation in IVF treatment.

Some studies suggest that PRP may support ovarian function, improve endometrial quality and increase the likelihood of embryo implantation. In reproductive medicine, women treated with intraovarian PRP injections showed significant improvement in FSH, AMH, and AFC (Antral Follicle Count) and re-establishment of menstrual cycles in post-menopausal patients achieved with this method. 

Combination of Stem Cells (exosome) and PRP appears to give better results than PRP alone.