Methods of ovarian rejuvenation for women with decreased ovarian reserve

Premature Ovarian Insufficiency (POI)

Hello to all our beloved patients. Today, as usual, I will be summarizing an academic article for you. Today's topic concerns about patients with Diminished Ovarian Reserve (DOR) or Premature Ovarian Insufficiency (POI). The article titled "Ovarian rescue in women with premature ovarian insufficiency: facts and fiction" by Pellicer, Nuria et al. from Reproductive BioMedicine Online, Volume 46, Issue 3, pages 543 - 565, outlines three effective treatments for patients with DOR and POI as follows:

1. In vitro activation (IVA)

This treatment involves a surgical procedure where ovarian tissues are extracted and taken outside of the body to stimulate dormant primordial follicles. Various methods, including cutting the tissue into small pieces or treating with certain drugs or substances (such as PTEN inhibitor; bPV(HoPic)), are used. After the treatment duration, another surgical procedure is done to transplant the treated ovarian tissue back to the ovaries to allow the activated follicles to develop. This can either happen naturally or through IVF treatments. This procedure has been practiced in countries like Japan with relatively satisfactory results. However, drawbacks include having to undergo two surgical procedures and the use of additional drugs on the ovarian tissue, the long-term effects of which are not yet fully known, such as potentially increasing the risk of cancer or having effects on the offspring. This method is not yet widely popular.

2. Stem cells infusion

This involves using stem cells to rejuvenate the ovarian follicles. These stem cells can come from the patient's own bone marrow (bone marrow-derived stem cells; BMDSC), from the patient's blood after treatment with drugs that stimulate the production of blood cells (hematopoietic stem cells; HSC), or from the blood from the umbilical cord of a newborn baby (umbilical cord-derived mesenchymal stem cells; UCMSC). The method of administration could be through injecting into the blood vessels that supply the ovaries, direct injection into the ovarian tissue, or just administering drugs that stimulate blood cell production. These stem cells can produce high levels of growth factors and might have another cell division stage, leading to long-lasting treatment effects. Several studies have shown that using stem cells increases the chance of having more eggs, improved hormone levels, and potentially a successful pregnancy. However, there are concerns, especially regarding stem cells from the umbilical cord which are not the patient's own cells. Nevertheless, these UCMSC cells have a unique property in that they don't express their identity on their cell surface (allogenic), reducing the concern of the body's immune system reacting against them. A disadvantage is that these donated cells have to be cultivated in high-quality labs, undergo thorough testing before reaching the patient for maximum safety, leading to a high cost (several tens of thousands per treatment). The treatment result might also take about 3-4 months.

I hope this provides a clearer understanding of these treatments. For questions about dietary supplements, if you're at the point where stimulation results in only 1-2 eggs or none, dietary supplements might have passed their effective point.

(Note: The text provides an overview of the treatments and is meant to be informational. Individuals should consult with a medical professional for personal advice.)

3. Platelet-rich plasma infusion (PRP) 

Personally, I mentioned PRP for many times. It involves extracting the patient's own blood to separate and concentrate the platelets. These concentrated platelets are then activated and injected back into the patient's ovaries. It has been found that this method increases the initial number of eggs in patients. It leads to a higher number of eggs obtained from stimulation and a higher chance of conception. Additionally, it was discovered that there's an increase in embryos with normal chromosomes. The time to see results varies; for patients with diminished ovarian reserve (DOR), results can be observed between 1-3 months after treatment. For patients with almost no eggs due to ovarian insufficiency (POI), it might take 3-5 months to see the outcome. This is because PRP stimulates the primordial follicles, which may take up to 5 months to develop to a stage where they can be seen on an ultrasound (antral stage). It is observed that PRP is not very expensive, and the treatment outcomes are reasonably good. The doctor believes that currently, PRP seems to be the most cost-effective option.

For patients with DOR or POI, rejuvenating the ovaries is genuinely challenging. Hence, patients who are in this condition should seek treatment as soon as possible before time further impacts the situation.