PRP Treatment in IVF

What Is PRP (Platelet-Rich Plasma) and How Is It Obtained?

PRP is the plasma fraction in which platelets — the blood cells involved in clotting — are concentrated by processing (centrifuging) a person’s own blood through a special procedure. In addition to their role in blood clotting, platelets contain numerous growth factors (PDGF, VEGF, EGF, TGF-β, etc.) and other bioactive molecules that stimulate processes such as tissue repair, cell proliferation, new blood vessel formation (angiogenesis), and regulation of inflammation.

To obtain PRP, a simple blood draw is performed. The collected blood is placed in special tubes and spun in a centrifuge device at specific speeds. This process separates the blood into its components, and the platelet-rich plasma fraction is isolated from the other components (red blood cells, white blood cells, platelet-poor plasma) and prepared for use. The procedure takes approximately 30-60 minutes.

What Are the Uses of PRP in IVF? (Current Research and Applications)

The potential benefits of PRP in reproductive medicine are being investigated in two main areas:

1. Ovarian Rejuvenation / PRP Application for Poor Ovarian Response (POR) (Intraovarian PRP):

• Theoretical Purpose: In women with diminished ovarian reserve (low AMH, high FSH), of advanced age, or who have shown an inadequate response to medications in previous IVF attempts (few eggs developed), the theoretical purpose of injecting PRP directly into ovarian tissue is for the growth factors in PRP to activate dormant stem cells or early-stage follicles in the ovary, thereby increasing egg number and quality and improving IVF success.
• Method of Application: Usually under light anesthesia or sedation, PRP fluid is injected into both ovaries with a thin needle under vaginal ultrasound guidance. The procedure is similar to egg retrieval (OPU).
• Who May Be Considered (Experimentally): It may be tried as a source of hope in selected patient groups with very low ovarian reserve, at risk of early menopause, or who have not responded to previous treatments, once all other options have been exhausted.
• Scientific Evidence Status: There is not yet sufficient, robust scientific evidence regarding the efficacy and safety of PRP injection into the ovaries. Most of the studies conducted are small-scale, lack a control group, or are methodologically weak. Results are variable, and many more well-designed, randomized controlled trials are needed before this method can be recommended as a standard treatment. It is currently considered an experimental treatment.

2. PRP Application for Thickening the Uterine Lining / Increasing Embryo Implantation (Implantation Failure) (Intrauterine / Endometrial PRP):

• Theoretical Purpose: For an embryo to successfully implant in the uterus, the uterine lining (endometrium) must reach a certain thickness and structure. In cases where the uterine lining does not thicken sufficiently (thin endometrium) or where pregnancy does not occur despite previous good-quality embryo transfers (recurrent implantation failure – RIF), the theoretical purpose of applying PRP into the uterus before embryo transfer is to thicken the endometrium, improve its blood supply, and make it more receptive to the embryo through growth factors.
• Method of Application: Usually in the cycle in which embryo transfer is planned, 2-3 days before transfer (or at another time determined by the doctor), prepared PRP fluid is delivered into the uterine cavity through a thin catheter in a simple procedure that does not require anesthesia.
• Who May Be Considered (Experimentally): It may be considered an option in patients whose uterine lining has not thickened sufficiently in past attempts (generally < 7 mm), who have experienced recurrent implantation failure, or whose endometrium has been damaged due to Asherman’s syndrome (intrauterine adhesions).
• Scientific Evidence Status: Studies on endometrial PRP application are more numerous than those on intraovarian PRP. Although some studies report an increase in endometrial thickness and improved pregnancy rates, particularly in patients with thin endometrium or RIF, the results are still inconsistent. The PRP preparation methods, timing of application, and patient groups used vary from study to study. This application is also not yet accepted as a standard treatment, and more randomized controlled trials are needed to definitively prove its efficacy.

What Are the Potential Advantages and Risks of PRP Treatment?

As with any medical application, PRP treatment has potential benefits and risks:

Potential Advantages:

• Autologous Nature: Since it is obtained from the person’s own blood, it carries no risk of allergic reaction or tissue rejection.
• Safety Profile (General): It is generally considered safe since no foreign substance is introduced into the body.
• Rich in Growth Factors: It contains a high concentration of natural growth factors that can support tissue healing and regeneration.
• Minimally Invasive: In particular, the intrauterine application is a fairly simple and minimally invasive procedure. The ovarian application also has an invasiveness similar to OPU.
• Source of Hope: It offers new potential hope, particularly for difficult patient groups for whom other treatment options have been exhausted or unsuccessful.

Potential Risks and Disadvantages:

• Infection: As with any injection or intrauterine procedure, there is a rare but real risk of infection. Attention to sterile conditions is very important.
• Pain and Discomfort: Temporary pain, cramping, or spotting may occur, particularly after ovarian injection.
• Uncertain Efficacy: The most significant disadvantage is that its efficacy in IVF has not yet been clearly proven scientifically. It is unclear how much of the observed positive results are due to the actual treatment effect versus a placebo effect.
• Lack of Standardization: The PRP preparation kits, centrifugation protocols, and application methods used in different clinics are not standardized, which can cause results to vary.
• Cost: It generally adds an extra expense to the standard cost of IVF treatment and may not be covered by the Social Security Institution (SGK) or private insurance.
• Unnecessary Hope and Resource Use: There is a risk that a treatment of unproven efficacy may lead to false hope, particularly for couples in a sensitive process, and waste limited resources (time, money).

Current Scientific Opinion and Recommendations on PRP Treatment in IVF

International reproductive medicine authorities (such as the American Society for Reproductive Medicine – ASRM, the European Society of Human Reproduction and Embryology – ESHRE) and health authorities in many countries state that PRP applications in IVF (both ovarian and intrauterine) are currently experimental. They emphasize that there is insufficient evidence for routine clinical use, and that these treatments should only be considered within the scope of well-designed clinical studies or in highly selected cases, after the patient has been thoroughly informed and consent has been obtained. It is of great importance for patients to fully understand the uncertainties, risks, and lack of evidence of these treatments, as well as their potential benefits.

PRP Applications in IVF in Ankara and Prof. Dr. Nuray Bozkurt’s Approach

Prof. Dr. Nuray Bozkurt closely follows all developments in the field of reproductive health, while always basing her treatment recommendations on the principles of evidence-based medicine. Her approach to new and still experimental treatments such as PRP is as follows:

• Information and Counseling: She openly and honestly explains to her patients what PRP treatment is, its theoretical mechanism of action, its potential areas of use (ovarian, intrauterine), and, most importantly, that the current scientific evidence is limited and insufficient and that the treatment is considered experimental.
• Risk/Benefit Assessment: She discusses in detail the potential benefits (even if not yet proven) and possible risks (infection, cost, false hope, etc.).
• No Routine Recommendation: In light of current scientific evidence, she does not recommend PRP treatment as a routine application in IVF.
• Personalized Assessment: Considering the patient’s specific situation (for example, very difficult cases such as unresponsiveness to treatment or repeated failures), if all standard and proven treatment options have been exhausted, she states that an experimental option such as PRP may potentially be considered, but that this is a decision to be made while accepting its risks and uncertainties.
• Referral (If Necessary): If, despite all the information provided, the patient wishes to try this treatment or to participate in clinical studies where this treatment is applied, she can provide information or referrals regarding experienced and reliable centers or physicians in Ankara or other cities who apply this procedure within an ethical framework and with defined protocols. However, Prof. Dr. Nuray Bozkurt’s priority is to focus her patients on options with a solid scientific basis, rather than directing them toward treatments of unproven efficacy.
• Staying Current: She aims to provide her patients with the most up-to-date and accurate information by following scientific publications and guidelines on PRP and similar new treatments.

To learn more about new and evolving approaches such as PRP applications in IVF treatment, to assess in light of scientific data whether your own situation is suitable for such a treatment, or to discuss your other treatment options, you can consult Prof. Dr. Nuray Bozkurt at our clinic in Ankara. Please call 0538 983 18 78 to schedule an appointment for a personalized, evidence-based, and honest assessment. It is important to us that you have access to the most accurate information for your treatment decisions.