There's tons of studies and
animal models, lab,
and even in humans, showing that PRP does
improve quantity and quality of eggs
in a lot of women.
You also have another treatment
that's really interesting,
Ovarian Rejuvenation.
So I tried to read a little bit about it
and is it similar to what
maybe like PRP? Like platelet
rich plasma injections, or?
Yes, it's absolutely.
This is it. You know, the
PRP or platelet rich plasma,
it's called Ovarian Rejuvination.
It's really the patient's blood.
So we take blood from the patient,
four tubes.
She waits in the lobby,
We prepare the PRP from her own blood.
We do not add anything to it.
Every place does it differently,
so you have to be careful.
Some people add chemicals and calcium
and all that, and we don't.
Then we go
vaginally, like an egg retrieval
and we inject the PRP inside the ovaries.
This is done
at least two weeks
before you start IVF stimulation.
And the PRP is good for three months.
If you do, it May 1st.
It's good for month of May, June
to the end of July.
It improves
quality or quantity of eggs or both.
But it might not do anything either.
I always tell patients,
50% of patients
do extremely well on the PRP,
50%, it's like you gave them nothing.
Why?
We do not know, it's like everything else.
Some things -
some things work for others, some things
doesn't work.
Now, we've seen magic with the PRP.
There's tons of data,
tons of medical research, it's
not something that's,
"Oh my God, I heard about it."
No.
There's tons of studies
and animal
models, lab,
and even humans showing that PRP does
improve quantity and quality of eggs
in a lot of women.
Even in menopausal women,
believe it or not,
they have up to 1,000 eggs
left inside their ovaries.
So if you inject PRP,
they can wake up
some of those dormant eggs
because potentially they can be normal.
It's very useful for women
with premature ovarian insufficiency,
POI or POF.
We used to call them premature
ovarian failure.
I don't like the POF term
because it's really not a failure,
it's more of an insufficiency.
But it works very nicely
for those patients
because usually they're younger than 40
and they have good quality eggs.
So all they need is one or two eggs
to make a baby.
So in summary, it works very, very well.
We've had - we've seen magic.
I always post on my Instagram
a lot of patients
who talked about their successes
and their journey and their babies.
Wow.
So this is more a treatment
that you usually recommend
for your patients
that have primary ovarian insufficiency
or perhaps like diminished
ovarian reserve, like, essentially, or?
Yes. It can be -
it can be used for multiple -
it can be used for menopause
or no period at all
to wake up some of the dormant eggs.
It could be done for women
who have low number of eggs
to increase the number of eggs.
It could be done for women
who have poor egg quality
and they're making better egg quality.
And believe it or not,
a lot of women
who have abnormally genetic -
genetically abnormal - abnormally genetic -
genetically abnormal embryos.
Sorry,
I guess
it's the afternoon, I'm not -
not talking well, English.
But genetically abnormal embryos.
They have four time chance
of having genetically
normal embryos following the PRP.
Happy to go through the mechanism,
but it works mostly
on improving the egg DNA division,
in the ovaries.
So it's a big range of patients
that uses it.
That's why when patients ask me,
oh, what's the percentage?
What's the pregnancy rate?
It's very hard
to compare apples to oranges.
I can't lump everyone who's doing PRP
in the same pot and say,
Oh, your chances are 1% or 2% or 20%.
You have to - when you give a percentage,
you need a big sample size
of all the same category.
And when you come,
then I put you in this category
and compare you to others.
Got it.
I see.
So, so far there, there
you've seen like in the clinic,
really good success with this
treatment. Amazing.
As far as like publishing,
you guys haven't published yet
on any of the data, or?
I'm sorry, can you repeat that?
Have you guys published
anything about the PRP yet?
We've published a lot of studies.
If you go to PubMed,
PubMed, there is tons of studies.
We published many - at least four so far.
We just had the paper accepted
that showed
that we have four times increase
in genetically normal embryos
following PRP in women
with poor egg quality
and low ovarian reserve.
So yes,
there's tons of studies there. Happy to share with you if you like.
Awesome. Yeah.
And then so
do you think that
this would be the case where
if someone at another clinic was
perhaps they had gone through a cycle,
it didn't go well
and they were considering
donor egg,
this might be something
they would try before
moving to donor egg?
The answer is yes.
Look, I always tell patients,
I'm not telling patients
because I want their money to do PRP.
It doesn't matter to me.
Actually, they do
donor egg, it's more money for us.
I'm a very straightforward guy,
the more you know me.
But we are -
sometimes you hit
the road where, you know,
either donor egg
or you want to use everything else
before you go to donor egg.
Or maybe donor egg is not an option.
Doesn't hurt to try the PRP.
Because let me tell you,
I mean,
it did
it did a lot of magic
for a lot of patients.
And look,
I always tell patients,
even if it increases your chances by 5%,
meaning out of 100 women,
five will have a baby.
It's a baby. It's not a car.
So it's a huge thing.
So what
a lot of people cannot use donor egg
for religious reasons
or ethical reasons, right?
So they have no choice
but to work on their equality.
And I really think PRP
adds a lot of value
in giving those people a chance
or an extra chance
by having a baby with their own eggs.
Yeah, definitely.
And so, I'm curious, so you said that it would be -
someone would do PRP about two weeks
before they would start their
IVF cycle or
like when during their cycle
would they do it?
Yes, at least two weeks.
The PRP and I -
I really think a lot of experts
think differently
because some people say it
takes six months.
I respectfully disagree.
I've seen its benefit up to three months
it and takes
at least two weeks to start working.
After three months, the effect is gone.
A lot of patients agree with me
because they see their period
comes regularly for three months
if they don't have a period
and now, boom, there is no more period.
It goes back to baseline.
That's why some patients,
they do one every three months
because if they want to,
if it works for them
and they want to bank
more eggs or embryos, then they do it again.
Got it. OK.
Wow, that's fascinating. Yeah.
So do we know like what the mecha- like
what is happening
that is improving the egg quality
when you do this PRP injection?
This is an hour conversation.
But in brief,
I always tell patients
your eggs right now
are all normal before -
when you, when you start a cycle
your eggs are 46 chromosomes
because humans are 46 chromosomes.
And the man is 46 chromosomes.
The sperm has to split in the testicle
to two 23-chromosome sperm. 23 and 23.
And the same thing for the egg.
Then 23 chromosome plus 23 chromosomes,
they meet to make a 46 chromosome embryo.
Now -
the follicle, when it's less than 10mm,
the DNA is still 46 chromosomes.
As it grows when it hits around 12mm to 14mm
This is when the DNA splits
right.
And then after that you can't change it.
Once it's split, it split.
How you stimulate the follicles to grow
from when they're small up to 12mm to 14mm
does affect how the DNA splits.
That's why we change protocols.
That's why we give this
versus different.
If you cook -
if you give them a lot of gonadotropins,
it's like you're cooking on
high temperature;
it's more likely to split faster
and unequally.
So instead of having two 23 and 23, it's
going to split 24, 22.
It's like cutting an apple unequally.
24
chromosomes plus sperm that's 23, now 47.
We call it trisomy.
It's an abnormal embryo.
So, PRP boosts the egg - the mitochondria
because it has human growth hormone
and a lot of growth factors that
that are good, that improves the engine,
that cuts the DNA equally.
It's like you're sharpening the knife
to cut the DNA
equally into two 23 chromosomes.
That's in summary.
Got it.
OK, that makes sense.
That's really interesting.
So essentially
the PRP
is helping with the 'machinery'
that's going to separate the chromosomes.
Exactly.
Got it.
So that you don't accidentally
miss some of them out, like they -
they divide evenly, essentially.
Exactly.
But that's why there's a lot of women,
their eggs keep splitting unequally into 24, 22.
And then when you give them PRP
now, with a gentle stimulation,
now their DNA is splitting equally
and they end up having genetically normal embryos.
This is why I told you
that the study that we just published
showed that it increased four times
the chances
of having genetically
normal embryo
following PRP in the same patients.
Wow.
We compare patients before and after PRP.
OK and after PRP
the same patients, in their cycle 2
they had four times
increase of genetically normal embryos.
That's great.
That's amazing that just that
and they don't
and they had to do it
not too far in advance
of going through another IVF cycle.
So they didn't even have to wait too long.
Like if people, you know,
because a lot of people worry about
having to do treatments
and then going -
waiting for their IVF cycle to start
because they're getting older.
So that's good that, you know.
You don't have to wait too long.
I don't - with my experience,
you really don't have to.
Wow.
And the injection you're doing.
Where are you injecting? Into the ovary?
Inside the ovary itself. Correct.
Okay, got it.
It's like the egg retrieval.
Instead of sucking eggs,
I'm now injecting PRP. Now every place -
every doctor or every place,
because now there's
a lot of people that do PRP,
it's really different.
I've had patients
who come to me to do PRP
and they've done PRP somewhere else
and I asked them how
they had the PRP
and they say, "Oh, we had one injection".
I really do it differently.
I inject multiple,
multiple
on the surface area of the ovary,
transvaginal ultrasound.
And let me tell you, it's not easy.
Especially when the women
have small ovaries and low number of eggs.
You really need to know where you're
putting the PRP
otherwise it's not going to work.
Got it.
OK, so there is a very specific area
that it needs to be placed.
Exactly.
So when it comes to
the Ovarian Rejuvenation,
someone asked
they asked a two part question.
So they want to know,
do you have any patients
that have been treated
in their 20s for low ovarian reserve
that did Ovarian Rejuvenation?
Yes.
So 1% of women in the United States
have something called POI or premature ovarian insufficiency.
Those by definition,
they're women younger than 40
and their period stopped.
So yes, I do have a lot of those women
who did PRP and have children.
Awesome.
And then, she also wanted to know,
how have they responded
to the treatment?
So, they responded by developing follicles.
A lot of those women
don't develop follicles.
So when we give PRP, because -
because, even though they don't ovulate,
they still have 1,000 eggs
left inside their ovaries
they started to ovulate.
Then we collected the eggs, fertilize,
and make embryos and have babies.
Got it. OK, awesome.
And then -
what is the best way
for people
to find out more
about you and your clinic
and the sort of treatments
that you offer?
Sure.
So our website is Rejuvenating Fertility Center.
My name is Dr. Merhi.
And if you go to our website
under our services, you will see a lot of
novel things that we do
under our services.
If you would like to contact us,
you can go to - on the website 'Contact Us'
and then fill in your information
and someone will call you right away.
You're also welcome to send me -
DM me on Instagram,
@dr_merhi. M - E -R - H - I.
Or on our Rejuvenating Fertility Center
Instagram account.