Two Peaks in a Pod

Celeb PRP Secrets: Can Kristin Cavallari’s Anti-Aging Hack Boost Egg Quality and Fertility?

• Beverly Reed • Season 3 • Episode 16

Share episode

Use Left/Right to seek, Home/End to jump to start or end. Hold shift to jump forward or backward.

0:00 | 32:19

Send us Fan Mail

Dr. Amber Klimczak and Dr. Beverly Reed discuss the how platelet rich plasma (PRP) is being used in the fertility world. They discuss some real life cases as well as the different avenues it is used for. They also discuss the available studies and data.

Watch this (Season 3, Episode 16) on Youtube or listen on your favorite podcast platform to Two Peaks in a Pod.

https://www.youtube.com/@peakfertility

https://podcasts.apple.com/us/podcast/two-peaks-in-a-pod/id1694248202

Links are in @drhappyeggs IG bio.

#fertility #womenshealth #ivf #hormones #prp #fet


Speaker

Hi, I am Dr. Beverly Reed.

Speaker 2

And I'm Dr. Amber Klumzak

Speaker

And we are

Speaker 2

Two- Two Peaks in a Pod

Speaker

Well, hi, everybody. Welcome back. Um, Dr. K, I noticed we are matching today.

I

Speaker 2

know. We are. It's like twinsies.

Speaker

But I've also noticed you've been wearing those- a lot this week. I was just curious about- This- Usually you mix it up with, like, different colors,

Speaker 2

but- This is, um- Is this your new favorite color? This is an issue right now in my house. Okay. We're, we're having a little domestic dispute.

Speaker

Oh,

Speaker 2

no. Okay. Um, so my loving husband- Uh-huh who I will say does a lot for our family- Yeah had to replace our washer and dryer because- Okay they weren't functioning properly. Oh, no. Okay. And the people came to haul off the dryer- Uh-huh and he let them take it with an entire load of laundry inside the dryer. So I'm missing, like, all of my scrubs. All your scrubs. My children are missing all of their essential clothes. It's bad. I'm- Are

Speaker

you telling me you're wearing dirty underwear

Speaker 2

today? Well, I have s- I have some extra underwear, but scrubs, you know, you get kind of desperate.

Speaker

I know. Oh, no. Okay. Well, you still look fabulous.

Speaker 2

It's so bad.

Speaker

And everybody's grateful Steven. He's probably in his doghouse

Speaker 2

right now. Oh, my... It was not a good conversation this morning.

Speaker

Actually, that is such a good segue- Mm-hmm into our topic, because one of my favorite celebrities, we're gonna be talking about her today, is Kristin Cavallari.

Speaker 2

Oh, yeah. Do you know her? She's cute, yeah.

Speaker

Mm-hmm. Okay. Did you ever watch the show- Of course back in the day, Laguna Beach?

Speaker 2

Of course,

Speaker

yeah. And you know one of her famous lines, right?

Speaker 2

No. What? Tell me.

Speaker

Steven."

Speaker 2

Oh, yes. Steven.

Speaker

Of course, Steven was the hot guy- Yes,

Speaker 2

yes

Speaker

of the show that everybody was fighting over. Yeah. And she would always say it like,"Steven."

Speaker 2

Yeah.

Speaker

So I'm like- I wonder if you say that at home to Steven. So, um, but anyways, um, Kristin Cavallari, I mean, she's just been killing it in her career overall. Just love everything she does. She has a jewelry line and a home line and all these things. But, um, I was watching a little clip from her podcast, and she was talking about how she still looks so great these days. I mean, she's older now, and she still looks amazing.

Speaker 2

And- She is so cute

Speaker

Oh, she's so... Yes. Yeah. Absolutely. And

like-

Speaker 2

And she's married to a football player, right?

Speaker

Well, they got

Speaker 2

divorced. Oh, shoot. Okay. Yeah. Oh, that's sad.

Speaker

Um, but actually it's really fun because right now they're having a Laguna Beach reunion.

Speaker 2

Oh.

Speaker

So I've been seeing all these social media posts with-

Speaker 2

Yes, I saw this. LC LC

Speaker

and Kristin used to fight-

Speaker 2

Yes

Speaker

and all the rest of it, and now they get along.

Speaker 2

Yes, I saw that too. Yeah. It's cute.

Speaker

Yeah.

Speaker 2

Yeah.

Speaker

Yeah. Um, but anyways, Kristin was talking about how she likes to stay young, and she really doesn't like Botox. And this really- Hmm piqued my interest because, you know, I've tried Botox several times, and every time I get it, and thank goodness I have a truth teller, my husband is like,"Okay-" You look crazy. He's like,"You cannot do it." Like, he's like,"I get it looks good on some people. It doesn't look good on you."

Speaker 2

What, like, what, your eyebrows go nuts,

Speaker

like, a little high? He said my eyebrows look crazy. Yeah. Like, I think they get this, you know? And like, I am very expressive. Yeah. So I, like, try to move my face, but it only halfway moves and I look crazy. So he's just like,"Please don't do that. Please stop." And I'll cal- I keep, like, trying different people, different And he's just like,"This is not working for you." So okay, so Kristen says she doesn't do Botox. I'm like,"Great, what are the alternatives?" And she said the magic word, which is she gets PRP treatment- Ooh under her eyes. Mm.

Speaker 2

And

Speaker

that got my attention right away because, wait a second, we're fertility doctors and we do PRP. And I'm like, wait, could I just be shooting myself up with it here? I

Speaker 2

need that. Yes. Yeah. The under eye. Yes. That's amazing.

Speaker

Yes. Okay. Yes. Um, so I figured let's talk all about PRP. Mm-hmm.

Speaker 2

And

Speaker

first, um, I just really wanted I'm just so excited to talk to you about it because I consider you the PRP expert at Peak Care. Mm. You know everything about PRP. You've got this great training. And so first I just figured maybe you could tell us about PRP, but I also wanna know how did you even get into this kind of niche of PRP?

Speaker 2

Yeah. I mean, it's really interesting'cause PRP is such a hot topic right now. Mm. All the different areas of medicine are trying to employ it for different- Oh, for sure uses. Yeah. Uses for sure. I think the really nice thing is we are all looking at it. Yeah. So it is being heavily studied right now. Yeah. So I think that that's really encouraging. So- PRP, platelet-rich plasma, is made from your own blood. This is one of the things that I love about it. Yeah. Right? Because in our world of fertility, we kind of get a bad rap because we inject people- Mm-hmm with these foreign medications and substances, right? Yeah. No one wants to do our treatments- Yeah because they're scared of our medications. Yeah. But PRP is so natural. It's your own blood that we make- Yeah it from. So I l- Yeah. Yeah. I love that. Mm-hmm. And because it's your own blood, there's actually been no documented allergic reactions to PRP. Mm-hmm. Pretty much any other medication you take, someone's gonna at some point have allergic reaction. Yes. Right? Yeah. So that's also really nice. In general, it's very low risk. So the way it's made is we draw your blood, and then we spin it in a special centrifuge to separate out that platelet-rich part of your blood. Inside the platelets in that, in that section of the blood, there's growth factors, right? That these are those... I'm... I kind of imagine them as, like, little factories that wherever you put them- Yeah they're gonna recruit all of the good things that we want, right? Mm-hmm. So yes, you can put it in your face. In ortho, you can put it in your joints, right? They're putting it in all different places. We are interested in putting it in your reproductive organs, right? So your ovaries and your uterus, depending on what's going on with you. And the thought is it's going to, wherever it goes, it's going to recruit things like VEGF. These are some factors that make you grow blood vessels to that area, increase the blood flow, and decrease cell death. The fancy word for that is apoptosis. So wherever we're putting it, there's basically more blood going to it, increasing that growth and stimulation, and less cell death, and that's really what we want, especially in the ovaries, especially in women who previously maybe didn't have great response to medications or weren't doing well with fertility treatments

Speaker

Yeah. And I, what fascinated me when we were first learning about this is whenever I heard the word platelets, what I think about is,"Oh, that's the substance of your blood that helps your blood to clot," right? And so to know that platelets are filled with all these amazing growth factors was really exciting to find out that they have another function besides that, which is really cool. Mm-hmm. But it is true, I am just seeing PRP everywhere. Um, and sometimes it makes me a little suspicious. Like, wait, is this a scam or something?'Cause I see that they're injecting it in the scalp for hair loss- Oh,

Speaker 2

need

Speaker

that too in the skin for wrinkles. Yes. Um, I went to the dentist, they wanna inject it in my gums. Oh. And, um, and so it's just interesting to just kind of see where... I'm like, are we just squirting this stuff everywhere now? Yeah.

Speaker 2

Um,

Speaker

but, um, I think it's interesting because if it's helping every single part of your body, I guess it does make sense that it could help your reproductive organs as well. Right,

Speaker 2

right.

Speaker

Um, but I just wanted to know, like, you're kind of the person who got me into this, but who got you into

Speaker 2

this? Yes. Yeah. So my co-fellow, where I did my fellowship at RMA, Reproductive Medicine Associates, her name is Dr.- Dr. Nola Herlihy, her thesis was actually looking at ovarian PRP in a very specific patient population to see if it could yield any benefits. Mm-hmm. And so in fellowship she had to learn how to inject PRP into the ovaries in order to do this randomized control trial. Mm-hmm. Um, and I was kind of along for the ride. Yeah. So it was- The important part yeah, so it was nice. Yeah. I was able to see how she makes it and learn how to do the procedure. Um, it's interesting because it's really just like an egg retrieval in reverse. That's how I describe it to my patients. Mm-hmm. So you are asleep under anesthesia,'cause we don't believe in torturing women, right? Oh. So we're gonna poke your ovary with a needle. We don't want you to be awake. And so it's attached to a transvaginal ultrasound, just like you'll have for an egg retrieval, and we puncture through the vaginal wall, and then we poke the ovary in four quadrants, and we put one milliliter of PRP in each of the four quadrants on both sides of the ovary. And so she trained me on how to do it. Mm-hmm. Um, and her study was really interesting. We looked at a lot of different things. We can talk a little bit later about some of the results. Yeah, yeah. But, um, definitely helped me to learn more about PRP and its utility.

Speaker

Yeah. And I will say- I would consider this cutting edge. I would consider this more experimental. And so sometimes as fertility doctors, we're hesitant to offer treatments like that. But really, I s- I would say part of the reason we started offering it is our patients demanded it from us. Mm-hmm. We would tell them,"Look, we're not sure how well this works or who it best works for," and they said,"Well, if you're not doing it, I'm going to New York," or,"I'm going to California," or something. And of course we're fine with people going other places, but we just felt really bad that then they had all these travel expenses. They were paying for their flights, their hotels, and then the prices for this in New York and California were really high. And so it was the discussion that we had together of- Hey, is this a treatment we should offer who-- for patients who want it, who would otherwise have to go somewhere else? We do really wanna help our patients. I think importantly, we have to be transparent about the available data for this. But I also have gotten to see some of the stories, and, and the patients now have gone through it, and I'm really excited about the possibilities for, um, the future as well. Yeah. But also, there's kind of all different indications or uses for PRP. Mm-hmm. And so first, I wanted you to tell us a little bit more about probably the most severe patients that we give it to, which are patients who have gone into premature menopause. This means that even though they're young Sometimes even 25 years old, for example, they're, they've run very low or almost out of eggs and they're menopausal. They've stopped having periods. And patients like this are not candidates for traditional treatment. Um, and since they're not ovulating on their own, th- ho- honestly, there's very little hope. We do know they have about a 5 to 10% lifehe- uh, lifetime chance of having a baby on their own. But that can feel really frustrating for a patient who really wants to try anything. So tell me about some of these patients,'cause I honestly have been pretty impressed with what I'm seeing on your part.

Speaker 2

Yeah. Yeah. So let me... One comment first. Yeah. So I think this is important. This is what I say to my patients- Mm-hmm when we're talking about PRP. In medicine, we talk a lot about the risk-benefit ratio-

Speaker

Yeah

Speaker 2

of anything we're gonna do, right? Yeah. That's what we use as your physician in order to help guide you into a treatment we think is worth it or not worth it. And I think the really positive thing about PRP is the risk is so low- Mm-hmm that even if the benefit is moderate or low- Mm-hmm it kind of balances out that ratio. Right. Right. Right? And so when I'm counseling my patients, I kind of explain that to them. As opposed to maybe some of even the other treatments that we've seen, Omnitrope growth hormone, right? Yeah. These other things that are out there, I think are a little bit harder, right? You're skewing that risk versus benefit. Mm-hmm. So that's how I counsel them. Now, for a premature ovarian insufficiency patient or a POI, premature menopause patient, they're out of options. Yeah. There's really not a lot of good options for them. So when you talk about that risk versus benefit, the benefit's probably there for them- Yeah because there's just nothing else. Yeah. Right? Mm-hmm. Um, and so the really interesting thing that I've seen with my POI patients- Mm-hmm is they'll come to see me sometimes as a last resort- Yeah and they have not had a period in over a year, right? Maybe they haven't bled in a long time. Yeah. And so we try and do everything we can to stimulate an ovulation event in these patients. They can still randomly ovulate, but it's very unpredictable in nature, right? It might just happen once every two years. But what I have seen is when we administer ovarian PRP, we can actually trigger them to ovulate one to two months later. Very interesting

Speaker

Yeah. And I think when you say- Mm trigger them to ovulate, sometimes that can feel confusing- Mm'cause we do sometimes give trigger injections-

Speaker 2

Ah, ah, yeah.

Speaker

Mm-hmm to ovulate. But I think what you mean is they're doing it on their own,

Speaker 2

right? Correct. After the PRP. Yes. Yes. So

Speaker

you're kind of waking up their ovary

Speaker 2

again. Yes. Yes. Which is very interesting. Mm-hmm. It's really helpful- Yeah because, one, we anticipate it. Yeah. We can catch it. Mm-hmm. Um, and what I've learned with modern relationships, not everyone's having intercourse three times a week. Yeah. So it's hard when you're only ovulating- It's really hard once in two years. You probably didn't have sex that week. Yeah. It's hard.

Speaker

Well, and here's the other thing that's very challenging for patients in that particular situation is traditional ovulation predictor kits do not work with them- Yes because their pituitary hormones are very high, their FSH and their LH. And if you take an ovulation test, it's always gonna be positive, and so you can't really track at home like the average person can. You really are kind of mainly having to monitor by ultrasound. But, um, it really kind of caught my eye because you had had a patient where you had given her PRP, and I had looked at her lab results before it. I said,"Oh my goodness, this poor lady. Her, um..." She was, I think, 40 or 45. Mm-hmm. Her FSH was 45 or something, very high, and I thought,"Oh, this poor lady." Um, but you had done PRP on, on her and then you were out. And I saw, yes, she resumed cycling, and then I saw she was pregnant from just insemination treatment, which was shocking to me.'Cause with... A lot of times we hear about patients needing IVF or things like after that, but- I thought,"Oh my gosh, I didn't even know what was possible." And I just honestly thank you for that, for showing me what's possible. Because prior to that, I think I would've seen that age combined with the FSH, with that AMH of zero and think there's, there's no hope. But now you've given me hope for-

Speaker 2

Yeah

Speaker

patients that are in a similar situation

Speaker 2

to me. Yeah. Yeah. So the goal is, okay, if we can get you to ovulate, we'll monitor with ultrasound to see, okay, now we see this follicle, and we try and time it with an IUI just to increase our chances as much as possible. And I will say, I mean, that patient ovulated a few times. We have done- Ah. Um, we've done PRP a couple times with her, and she'll ovulate after. She knows. Ah. Yeah. So, um- Yeah I have had actually quite a few patients that will do that. So- Yeah I know if you're listening and you're a POI patient, there's just not a lot of doctors out there that I think are even willing to treat you- Yeah because they just feel like they don't have a lot to offer. So I do think that's something you can maybe ask your doctor about.

Speaker

Yeah. Well, and I love how you talked about that risk-benefit ratio, because I will say I had a patient recently who came in, and she's 50 and has all, all the same stats and everything, and I really recommended against it for her- Mm-hmm because I felt, you know what? For her, I just thought the statistics really didn't match up with a good chance of that working for her. So I do think it's probably reasonable to have some sort of age limit. Mm-hmm. I, you know, I, I think for, in perusing for my patients, maybe 45. If you're less than 45, could be reasonable for you to try it. If you're 45 and above, might be better to think about other options. Um, but it's very personal, too. And here's the thing, like if... Sometimes patients will ask me,"Well, what would you do in this situation?" And I say,"Well, you're not gonna like my answer, because I would use an egg donor." Mm-hmm. Like, I'm so desensitized to the concept of using an egg donor that I just don't think it's a big deal.

Speaker 2

Mm-hmm.

Speaker

But also, patients are all different, and for some of our patients, they sometimes have religious reasons where they're not even allowed to use an egg donor. And so it's either try some experimental treatments or potentially never have a baby. And so that's why I always think it's, um, fair to have those discussions with, with your doctor- Mm-hmm about what the right, um, answer is. So, um, okay. So that's premature ovarian insufficiency patients, but that's a pretty small group of patients overall. I also wanted, um, to talk about use of PRP for thin lining Or implantation problems or even miscarriage issues. And this was really interesting because I saw that recent study, I mean, I guess it's been a couple of years now. It was in twenty twenty-four. It was a Cochrane review. What that means is they take all the studies available, and they put them all together to try to make a conclusion by looking at all those studies. And the conclusion was that for those indications, there did appear to be some benefit if you are instilling PRP. That means you are essentially squirting the PRP into the lining, um, prior to the implantation. However, they did make the caveat that, you know what? All these little small studies were not really high-quality studies. So they really couldn't... They didn't feel like it was a final conclusion, more so,"Hey, we're seeing some positive signs," but it hasn't been totally decided yet. And thus, it's not standard of care. It... Not all fertility doctors are recommending it yet. And so I think for me personally, and this is one that I offer, um, as well, I usually try all the other things first that we would usually try for thin lining. But as a last resort, I've been trying it and I've had some good success with it too. Again, just maybe a low number of cases overall, not enough to be, you know, 1,000 patients in a study or anything like that. Um, but, but that's been my experience is it, is it may be helpful. But I was fascinated because you did PRP recently in the lining of the uterus, but you did it differently how I did it. Yes. So can you- Mm-hmm explain to them how you did it? And I, I was fascinated

Speaker 2

by this. Yes. Okay. So comment about what you were talking about. This is kind of funny because back- Mm-hmm in fellowship, you know, where I was, we did a ton of research. Yeah. And so we were always looking at, like what's the- Yeah up-and-coming thing, what should we be looking into? Brent Hanson, one of my other, uh, co-fellows- Mm-hmm Dr. Hanson, um, wanted to do a study on recurrent implantation failure in thin lining. Mm-hmm. And the reason why this Cochrane review has so many small number studies- Mm-hmm is because the patients don't exist. Mm-hmm. This is what's so weird, right? Yeah. I feel like anecdotally in my practice- Mm-hmm I have a ton of patients with thin lining. Yeah. Like, to me, my perception is- Yeah there's a lot of patients out there with thin lining. Yeah,

Speaker

yeah.

Speaker 2

But it's actually not true. Yeah. When you start and go looking for them- Yeah it's a very small- Yeah subset of fertility patients. It's actually a really rare find. Mm-hmm. And we could not find the patients Mm-hmm to do a randomized control trial. Oh, interesting. That is why those numbers are so small, and how it's- Oh and why it's low-quality evidence for- Yeah anything out there, the NutriGen studies, anything. Yeah. It's very hard- Yeah to find enough patients- Yes to get what we call a, the amount of power we need to detect a difference- Yeah in a randomized control trial. So that is why that is- Mm-hmm the way it is. Not that I don't think that there can be some benefits to doing treatments to lining- Yeah it's just, it's hard to study it'cause it's a, it's pretty rare, even though it doesn't feel like that. Yeah. Um, but I have done endometrial PRP where we instill it. Mm-hmm. Instilling, the way I kind of think about it, is like an IUI. Yeah. If you've ever had an insemination, you're kind of just spraying it into the lining, letting it sit there. And in my mind, like, my hypothesis about- Mm-hmm when I've studied PRP and looked at it, I feel like it really needs to inflict more. Like, I have concerns about just putting it on something. Mm-hmm. I think it needed to be injected. So I looked to see, especially for one of my really severe thin lining patients- Mm-hmm is if anyone is injecting it into the endometrial lining. And there are some people out there that were doing it hysteroscopically. So you have the hysteroscope, which is a camera, through the cervix, into the uterus, and then you actually use the needle to inject it right underneath the lining. Mm-hmm. And I did that, and I had fantastic success. Mm-hmm. It was the first time my patient ever grew a lining. Amazing. She's nine weeks pregnant. Yay.

Speaker

Oh

Speaker 2

my gosh. Yes. That's amazing. So that was- Oh I mean, really a big, um- Mm-hmm success with it. Yeah. And again, so safe, not really a lot of risk- Mm-hmm to do it that way. You're doing it under camera visualization. Mm-hmm. So I do think it's a good utility for PRP. Interesting.

Speaker

Okay. Well, good job. Yeah.

Speaker 2

See, you're just a PRP

Speaker

queen. Okay, perfect. So we've talked about premature, um, ovarian insufficiency in PRP. We've talked about thin lining or implantation problems in PRP. Now let's talk about IVF Okay. I can think of a couple of patients where, again, I've just been fascinated by what you did with them. And so, um, let's maybe start with the first patient. Um, this was kind of when we first opened. I remember you had just the kindest, most lovely patient. She kept trying IVF, wasn't working. I think you had recommended using an egg donor for her. She just didn't want to. And so you did PRP on her. And tell me what the differences were that you saw in her IVF after.

Speaker 2

Yeah. So, um, a lot of times with her IVF, she wouldn't even get eggs at the time of retrieval, um, for one reason or another. And ultimately, she definitely never made an embryo previously. So that's what I was working with. Either no eggs at all, right, not responding to medications to even get to retrieval. Mm-hmm. Definitely no embryos. After we did PRP on her, it was the first time she actually grew embryos. Wow. Created blast. Now, I will say they weren't great quality blast. Yeah. And again, this, I'm gonna... I can, you know, talk more about the data. Yeah. But this is what's really hard with research, right? Yeah. Just because we're moving the needle- Yeah doesn't mean we're getting all the way to the endpoint that really is an- Yeah important, meaningful outcome. Yeah. Um, but it's hard to kind of abandon- Yeah these s- s- um, interventions- Mm-hmm just because they're not getting to the outcome. Like, I think that we still need to be exploring it in bigger populations of patients. Yeah.'Cause I will say, for example, that patient was probably one of the worst prognosis patients.

Speaker

Yeah.

Speaker 2

There's a really interesting 2025 study that came out that probably says we should do, be doing PRP on a different group of patients. Yeah. This is what I've been talking about, uh- Yeah recently. Yeah. And that patients who have an AMH above one- Mm-hmm but are low responders, are probably gonna get the most benefit from PRP. Mm-hmm. And that is not who I'm doing it on.

Speaker

Yeah. Right.

Speaker 2

It's not. Right. Yeah. I'm doing it as a last resort.

Speaker

Yes.

Speaker 2

Yes. Yeah. You know? So I think it's really interesting to see- Yeah if we kind of had someone that had a little bit more to work with- Yeah,

Speaker

yeah

Speaker 2

what could we do with them?

Speaker

Yeah. Well, what I love in that patient's situation is you gave her a chance, and I know, you know, previously she had zero chance- Mm-hmm because she wasn't making any embryos. Mm-hmm. And then she had two chances. She made two embryos. Mm-hmm. I know she did try with them. Ultimately, it didn't end up working. She did move on to an egg donor, got pregnant, and had her happy ending. But I think part of her happy ending was the fact that you

Speaker 2

let

Speaker

her find closure- Mm-hmm with getting to use her own eggs and everything. Um, and so I, I still am fascinated by that. Um, but I... But as you pointed out, that's probably why it's impacting the studies. But I mean, oh my gosh. As you bring up trying it on other patients, I was just so impressed with one of my recent patients that you did PRP in. And I don't even think I've given you the final update yet. But, so this patient, um, that had done IVF three times with me, um, I've actually talked about her on another podcast'cause I was just so excited, um, to share what happened with her. But her first three retrievals, um, pretty low response overall. We did get some embryos, but they came back as genetically abnormal. And we had just, like, we would usually get one embryo per cycle. Or even on her third cycle we didn't even get any eggs. It's like her response was just getting worse and worse as we went along. They were not open to using an egg donor. They said,"Look, if this is not gonna work, we're just gonna close our journey." And I said,"Well, there's one more thing you can try." And I said,"Look, I mean, I just don't know how much it would help. It's not like you're in premature menopause or anything. But knowing you didn't get many eggs, do you wanna consider trying PRP with Dr. K?" So you did PRP on her. You did it twice. And what's interesting,'cause I know you're collecting your data for research purposes, is we had checked her AMH, um, right before the PRP, and it had dropped down to 0.5. It was pretty low. Um, she came to see me, and it was pretty soon after the second PRP you did on her. And I looked at her ovaries and I'm like,"Did you give my patient PCOS?" PCOS is a condition where you've got lots of eggs. Uh-huh. And I'm like,"Are these the same ovaries?" So I recheck her AMH. And in that short period of time it had gone from.5 to 1. It had doubled in that very short period of time. Thought,"Wow, that's, that's exciting." But I'm like,"Well, I don't wanna get my hopes up." So I'm like,"Well, let's try her IVF," right? During her stimulation she responds faster than she ever had. She traditionally had very long stimulations. You know how an, an average- Mm-hmm stimulation would be, like, 10 to 12 days? She would go, like, 15, 16 days.

Speaker 2

Hate that. And that- You know how much I hate that I know. It's so bad. And that's, like- Yeah

Speaker

a long time for those follicles- Yes to make those tomest- Mm uh, tomatis and everything. But they just wouldn't grow anyhow.

Speaker 2

Yeah.

Speaker

Well, they grew, grew so fast I was shocked. I'm like,"Why are they growing so fast?" And then I'm seeing this response and I'm like, okay, again, trying not to get my hopes up, right? 17 eggs at retrieval. Way more than she'd ever had. Again, I'm thinking,"Let's not get our hopes up." She ended up with 10 embryos.

Speaker 2

Crazy.

Speaker

10. But I'm still like,"Let's not get our hopes up." Okay, let me give you the final update. At 41 with 10 embryos- Mm five of them were genetically normal.

Speaker 2

That's insane.

Speaker

I was

Speaker 2

just like,"What?" That's crazy. I'm

Speaker

like,"Dr. K. is

Speaker 2

a magician." That is a very- Or a

Speaker

v-magician. Yeah. That,

Speaker 2

that is a very good outcome. Um, amazing. Anecdotally great- I mean- great outcome. Yeah

Speaker

I... It blew

Speaker 2

my mind.

Speaker

Yeah. Again, you're showing me

Speaker 2

what's possible. Yeah. That's awesome. And

Speaker

I was like,"What?" Now, of course, we call this an anecdotal

Speaker 2

study. Yeah.

Speaker

I would love to see 1,000 women just like her, and I don't have that. Um, but this just showed me, for some people it seems to help. I guess some people... Critics could say,"Well, that was just a coincidence. She... That was gonna happen on her fourth cycle anyways." Maybe that's the truth, but that seems just too dramatic for me not to give, uh, some credit to PRP. Um, so I'm fascinated by that. Um, and, and so next, next stage is- Mm transfer for them. But, um- Really exciting but they were just as shock- I... By the way too, I also asked her,'cause I always wanna ask my patients when anything good happens,"Okay, what were you doing differently? Did you... Uh, were you on a different diet?" Mm."Were you taking anything different? Did you take a magic vitamin?""Did you take a magic supplement?" And she said,"No. I did nothing different." So anyways, good job again. Yeah. And, and so now I'm fascinated. And now when I have patients in that situation, it's kind of her story gives other people

Speaker 2

hope. Mm-hmm. Absolutely. You know? Yeah.

Speaker

I like that quote of,"Maybe you've been assigned this mountain to show other people it can be moved," and that was- Mm her mountain, you know? So.

Speaker 2

Gives me chills. That's sweet.

Speaker

Yeah, yeah.

Speaker 2

Mm-hmm.

Speaker

Um, okay. So, um, you had mentioned Dr. Hirlehie's study before- I thought that we should touch on it because it sounds like it was actually a really good study. When we look for studies, we want to see prospective, forward-looking studies, and we like them to be randomized control, meaning they've got two groups, one that's getting the treatment, one that is not getting the treatment, so we can get a good comparison of the two. And so can you... Do you have the inside scoop on that a little bit

Speaker 2

more? I don't know if I do really. Um, but yes, I think it was a well-designed, well-played-out study. Yeah. I think they really did stick to the initial design. It was multi-center. Yeah. So they had, um, actually a multi-country. Oh, wow. Really, one of the other, um, centers that they were doing that was in Turkey. Mm-hmm. Um, which I think is great, right? To have a really wide variety of patients, very heterogeneous. Um, and you know, we were looking at poor responding IVF patients. They basically had to meet these certain criteria to even be put into the study. Mm-hmm. And then you were either a control group or you were the group where they were actually doing the PRP. Mm-hmm. Um, now what we were looking for is we were trying to see is it gonna improve the IVF outcomes, ultimately pregnancy success and live birth. And it was a negative study. And I tell people this all the time, not because I want them to hear all these negative things about PRP, but just to share with them that there is-- there are negative, um, studies out there. We didn't find that it made a significant difference. But I always tell them the really interesting thing that Dr. Herlahey noticed is in tracking these patients on follow-up, many of them conceived on their own in the three to six months afterwards. And these are really low responding patients. And so one of the biggest concerns I have with the study is the timing. And this is the case with all research. What you don't understand behind the scenes with research is it takes us so long to actually get the study set up, so that by the time we're actually doing it, we really need to get the data done quickly- Yeah so that then we can analyze it and get it published. Otherwise, I mean, you're talking it could take us, like, five to six years, right? Yeah. So truly, once everything was teed up and ready to go, they had to do the PRP in one month, and then the very next month we did their IVF stimulation. Mm. And so this is part of what changed in how I do my protocol now. I don't think it's sufficient time. Yeah. Right? And there's data to show that maybe some of the peak effects happen at, like, the 60-day point, right? PRP maybe even lasts to 90 days or even six months- Mm it's doing something. So that's why I encourage my patients to even consider doing the two rounds of PRP- Yeah so you get some of those shorter term benefits, and then you get the longer term, maybe 60-day benefits. So I do think there was a lot that we learned- Mm-hmm from that study subset of women. Yeah. Um, but there was definitely some positives, I think- Yeah that came out of it. Um- Yeah but as a follow-up to that, what I share with my patients, similar to what you're talking about with the reviews, is there is a meta-analysis out there for intra-ovarian PRP. And the meta-analysis really does show everything that we're looking for. Mm. It shows that your AMH increases- Mm-hmm after a PRP. Your FSH decreases. Remember, that's what we want. We want low FSH levels, meaning your brain's not working that hard to make you ovulate. Increases in your resting follicle counts, just like Dr. Reedsall, right? When we scan your ovaries before and after, we see more little resting follicles ready to stimulate for us. Increases in the number of mature eggs retrieved at the time of an IVF egg retrieval, and then ultimately even increases in clinical pregnancy rates. Mm. It's the live birth data point that we don't have yet. Yeah. So that's what I'm saying. We're moving that needle. It's doing- Yeah a lot. And remember, most of these studies are done on really poor prognosis patients.

Speaker

Yeah.

Speaker 2

And- I

Speaker

saw in Dr. Hurley's, um, study, I think what they were kind of using as criteria is maybe you've done an IVF cycle before and you got less than three eggs- Mm-hmm which is so few. That's so hard when you have s- So few to even try with, I can understand why that's hard to show a difference in that population in particular.

Speaker 2

Right. Right. Exactly. Mm-hmm. So I'm extremely interested. Of course, I want to help. If you're a diminished ovarian reserve patient, I wanna help you. Yeah. Yeah. I'm happy to do it for you. But I'm also very interested to see I- if you're a lower ovarian reserve patient that maybe is just not stimulating as well- Yeah what can PRP do for you? Because I think that that's probably the population that's gonna have the most benefit- Yeah but we just haven't applied this to that.

Speaker

Yeah. Yeah. Mm-hmm. Amazing. Well, I'm sure more to come from you. Mm-hmm. I know you're so interested in research, and you're collecting your data and everything. And, um, I just love that you're really helping this group of women, because this is a group of women that are underserved,

Speaker 2

right? Mm-hmm.

Speaker

Um, because I do think, again, where sometimes patients don't like my answer, what do most, um, fertility doctors tell patients in situations like that? Use an egg donor, use an egg donor, right? Um, and for people who they're just not there yet or that's not an option, we've gotta have some other, um, alternatives. And as long as you, uh, talk with your provider about the risks, the benefits, the available data, I think it's okay, yeah, as women to try more cutting-edge therapies as well, so.

Speaker 2

Yeah.

Speaker

Amazing. Okay, good. All right. Well, um, we would so appreciate it if you guys left us a positive review, whether it's on the podcast page or our YouTube or even on our Peak Fertility practice, uh, page. That really helps us out a lot. And stay tuned for the next episode.

Speaker 2

Bye.