Dear patients and prospective parents, the field of reproductive medicine confronts us with a new technology or a treatment presented as a "miracle" almost every day. In order to push the success rates we achieve in assisted reproductive techniques (IVF) even higher — and especially to offer hope to patients with low ovarian reserve or an insufficiently thickened uterine lining (endometrium) — "regenerative medicine" applications have become quite popular in recent years. In this article I will address the scientific reality of "add-on" treatments frequently asked about in our clinical practice, such as PRP (Platelet-Rich Plasma) and Exosomes, together with the position of global authorities (such as ESHRE and ASRM), with both academic depth and language you can understand.

What is PRP (Platelet-Rich Plasma) and How is it Applied?

PRP treatment is in fact a product obtained from the person's own blood. A certain amount of blood taken from the patient is separated in the laboratory using special devices (a centrifuge), producing a plasma rich in the cells we call platelets. The feature of this plasma is that it contains abundant growth factors (such as VEGF, EGF, PDGF). This method, long used in other areas of medicine (orthopaedics, dentistry, etc.) to accelerate tissue healing, has two main goals in IVF:

Intrauterine Application (Intrauterine PRP): In patients with a thin uterine lining, previous recurrent implantation failure (RIF) or recurrent pregnancy loss (RPL), the aim is to increase tissue thickness and the chance of implantation.
Ovarian Application (Ovarian PRP / Ovarian Rejuvenation): In women with diminished ovarian reserve (DOR) or premature ovarian insufficiency (POI), it is applied to awaken dormant follicles and increase the number of eggs.

What Does the Scientific Evidence Say? A "Miracle" or an "Experiment"?

Although our clinical observations and some small-scale studies point to promising results, the data of "evidence-based medicine" — the highest step of medical science — tell us to be more cautious.

For Intrauterine PRP

Some systematic reviews report a slight increase in clinical pregnancy rates in patients treated with PRP. However, most of these studies were conducted with small patient groups and are methodologically weak and heterogeneous (containing very different protocols). Current ESHRE guidelines do not recommend intrauterine PRP in routine clinical practice because there is insufficient high-quality evidence.

For Ovarian PRP (Rejuvenation)

There are uncontrolled studies suggesting that injections into the ovary may increase the number of mature eggs, fertilisation rates and good-quality embryo formation. However, a robust randomised controlled trial (RCT) demonstrating whether this method actually increases live birth rates is not yet found in the literature. For this reason, PRP applications for ovarian rejuvenation are still considered experimental.

Exosome Therapy: The Cells' Secret Messengers

Exosomes are tiny vesicles that enable communication between cells and carry proteins, genetic material and growth factors within them. In regenerative medicine, these exosomes are thought to be the real power behind the effect of stem cells.

The role of exosomes in reproductive health is even newer and more limited than PRP. In animal models (rodents), there are data suggesting that exosome-containing fluids may improve ovarian function. However, there is insufficient clinical data on the efficacy and, especially, the long-term safety of exosome use within IVF treatment in humans. For now, these treatments should be evaluated only within strictly supervised research protocols.

Safety and Risks: What Don't We Know?

Because PRP is made from the person's own blood, it is often marketed as "natural and harmless". However, in reproductive medicine, safety is not limited to the side effects at the time of the procedure.

Effects on the embryo and fetus: The long-term effects of the concentrated growth factors injected into the uterus on the genetic expression or development of the embryo that will implant there are not yet fully known.
Carcinogenesis and other risks: In stem cell or similar regenerative treatments, the greatest concern is the risk of uncontrolled cell proliferation (tumour formation). Although this risk is considered low in PRP applications, the surgical risks of invasive procedures on ovarian tissue, such as infection and bleeding, are always present.

Conclusion

Treatments such as PRP and exosomes may in the future become part of our standard treatments; however, for today these methods are not a routine application but "add-on" treatments. When choosing these methods, you should decide by knowing that they offer no "guarantee", that their costs bring an additional burden and that their long-term results are still being researched — through transparent communication with your physician.

It should not be forgotten that IVF treatment can evolve into a long and costly process. Keeping this in mind, being cost-effective and communicating well with your doctor is the most important part of the treatment.

New Horizons in IVF: Do PRP and Exosome Therapies Really Work?