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The IVF Fertility Blog

Dr. Zaher Merhi's Presentation on Ovarian Rejuvenation


Good Morning Everyone! My name is Dr. Zaher Merhi and I am a Reproductive Endocrinologist and Infertility Specialist (REI) at New Hope Fertility Center in New York and am also the Director of Research and Development in IVF Technology. Today we will be talking about OVARIAN REJUVENATION for many reasons. For one, it is a cutting-edge technology that many patients are asking about because they read it online. Many centers all over the world are starting to do some type of Ovarian Rejuvenation, but they are doing their own versions, including us at New Hope Fertility Center.

Let’s talk a little bit about the anatomy of the ovary first and how the ovarian reserve changes with age.

So this is an ovary. These are the small follicles, here. This is a bank. All women are born with around 1 to 2 MILLION eggs, total! By the time she hits puberty, a girl will have about 300,000 eggs left and then she will start to have her period, and a regular menstrual cycle. Every cycle she will ovulate one egg, but she will also lose about 10-15 eggs every cycle in order to ovulate one egg. So this reserve runs out pretty fast until she hits menopause.

Now a woman’s peak fertility is typically in her 20’s, mid 20’s to 30’s. After age 35 the quantity and quality of eggs declines steadily until menopause. We have multiple tests to test for this:  Ultrasound, AMH- which tells us about the QUALITY of the egg. No test in the world exists to evaluate the quality until we get into IVF and can actually see the eggs.

It’s important to know that any woman, even menopausal women still have eggs in their ovaries. It’s not like they have zero eggs. But, the eggs are dormant and don’t grow because they don’t have an optimal environment for egg development. This doesn't just happen in women in their 40’s and 50’s but also in younger women. We call this Premature Ovarian Failure or Premature Ovarian Insufficiency, where women less than 40 years old stop having their period for more than a year and their FSH is very high and AMH is low. These patients have a 5%-10% chance of getting pregnant and don’t necessarily have to use an egg donor. There could be many reasons for this type of infertility.

If a woman has eggs and we can see them, we can move to IVF. The success is frequently determined by age because of the correlation of egg quality and age. If IVF doesn't work because we can’t see the follicles on the ultrasound, or her body isn’t responding to fertility medication, we can move to Ovarian Rejuvenation.

As of today there is a group in San Francisco and in Japan that use a surgery and they go through the belly button and take a small sample of ovarian tissue. In the lab they activate the eggs in the tissue in the lab and then transfer it back. You might have to do this more than once and it’s invasive. This makes clinical sense to reactive dormant tissue.

The other technique that is being done is PRP or platelet rich plasma. Similarly, it's a small procedure. We take blood, centrifuge it so the platelet rich plasma is accessible (or stem cells) and then reinject that back into the ovary. It’s less invasive, but you still have to go to a hospital.

Another technique is to inject stem cells directly into the ovarian artery. Same type of in-patient hospitalization needed during the procedure. There isn’t enough data to tell how successful this is.

Here at New Hope, we are doing something different, a modified ovarian rejuvenation technique. It’s less invasive than other approaches. Like an egg retrieval this is done here in the office, transvaginally.  We puncture the ovary multiple times to relieve the pressure from the rigid ovarian wall.  Mechanically, this rigid wall can push on the follicles and keep eggs dormant.

We had a patient that had cancer and so we removed her ovary prior to chemotherapy for transplantation after her treatment concluded. So we took out some of the tissue and when we transplanted it back, her ovary was functioning BETTER than before she had cancer. She regained a regular period in her 50’s and had increased fertility.

So we then started thinking that if we cut this tissue and relieve the pressure, the eggs will start being produced again. Similarly, the injections of PRP in the other technique is also simultaneously relieving this pressure. So their success might not be because of the platelets, but because of the aspiration of the ovarian wall. The plasma is already in the blood and pumping to the ovaries.  What’s the difference in taking it from the arm and putting it in the ovary versus just allowing the body to naturally supply this to the location?

We have had a couple patients that had this procedure and it worked. So we want more to continue evaluating. 

At New Hope, this question only takes 5-10 minutes, here in the office.

Another question is what fertility medication is used?

None. We don’t use any fertility medication for this.

Thank you so much for taking the time to listen to this talk. If you have any questions, please contact me on Facebook @Mr.Fertility or email iov@nhfc.com to book an appointment with me to discuss! I do Skype, Facetime, and phone consultations and we can evaluate your background and see if this new procedure could be right for you!

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