Ovarian rejuvenation is a day procedure in which platelet rich plasma, prepared from a sample of your own blood, is injected into your ovaries under ultrasound guidance, with the aim of improving how your ovaries respond. Dr David Knight performed the first intraovarian PRP procedure in Australia in 2017 and has carried out hundreds since, which makes him the most experienced practitioner of this technique in the country. It is most often considered by women with low AMH, diminished ovarian reserve, premature ovarian insufficiency, a poor response to previous stimulation, or those who want to exhaust every option before moving to donor eggs. The procedure takes under an hour, you go home the same day, and because the plasma comes from your own blood there is no donor material and no risk of rejection. It is an emerging treatment. The published evidence points to measurable improvement in fertility markers for many women, but not to a guaranteed pregnancy, and it is not suitable for everyone. This guide covers what the procedure is, how it works, who it suits, what the research actually says, what results look like in practice and what it costs.
What is ovarian rejuvenation?
It is a group of techniques that aim to improve ovarian function rather than simply stimulate the follicles already developing in a given cycle. In Australia the term is used almost exclusively to mean intraovarian PRP, which is the approach Dr Knight introduced here and the only one offered at Demeter Fertility.
The reasoning behind it challenges an old assumption. The traditional view is that a woman is born with every egg she will ever have, that the number falls steadily with age, and that once the ovarian reserve is depleted nothing can be done. Research in this field asks a narrower and more practical question: within the ovarian tissue that remains, are there dormant follicles that could be encouraged to develop, and can the local environment be improved enough to make a difference to an IVF cycle?
That is a more modest claim than the way this treatment is sometimes marketed. It does not reverse menopause, does not make a 44 year old ovary behave like a 30 year old one, and does not create eggs from nothing. What it may do, for the right patient, is improve the response to stimulation enough to change the outcome of a cycle.
How does ovarian PRP work?
What platelet rich plasma is
Platelets are the cell fragments in your blood responsible for clotting and tissue repair. They are also dense in growth factors, the signalling proteins that tell surrounding tissue to repair, form new blood vessels and activate local cells.
Platelet rich plasma is simply your own blood, spun in a centrifuge so that the platelets are separated out and concentrated into a small volume of plasma. Nothing synthetic is added. PRP has been used for years in orthopaedics, sports medicine and dermatology for the same underlying reason: concentrated growth factors delivered directly to the tissue you want to influence.
What the growth factors are thought to do in the ovary
Once injected into ovarian tissue, the working theory is that those growth factors act on the dormant primordial follicles that remain in the ovary. The proposed mechanisms include improved blood supply to the ovarian tissue, recruitment of follicles that would otherwise have stayed inactive, and a more favourable hormonal environment for the follicles that do develop.
In measurable terms, the markers watched afterwards are AMH, antral follicle count and FSH. A rise in AMH and antral follicle count, or a fall in FSH, suggests the ovary is behaving differently than it was before.
Why using your own blood matters
Because the plasma is autologous, meaning it comes from you, there is no donor material involved, no risk of immune rejection and no risk of transmitting infection from another person. This is one of the reasons the safety profile of ovarian PRP compares favourably with more invasive approaches to the same problem.
The ovarian rejuvenation procedure, step by step
1. Assessment and suitability
Before anything else, Dr Knight reviews your AMH, antral follicle count, FSH, age, treatment history and the detail of any previous IVF cycles, including how you responded to stimulation. The treatment may not be appropriate for everyone. If he does not think the treatment is likely to help you, he will tell you so at this stage rather than after you have paid for it.
2. Blood collection and PRP preparation
On the day of the procedure a sample of your blood is taken, exactly as it would be for a routine blood test. It is processed in the laboratory to separate and concentrate the platelet rich plasma. This takes a short time and happens while you are at the clinic.
3. Ultrasound guided ovarian injection
The concentrated plasma is injected into both ovaries using a needle guided by transvaginal ultrasound. The approach is the same one used for an IVF egg collection, so if you have been through IVF the experience will feel familiar.
4. Recovery
The whole process usually takes under an hour. Most women feel well afterwards and return to normal activities the same day. Some experience mild cramping or spotting for a day or two, similar to what follows an egg collection.
5. Monitoring and review
Your fertility markers are retested over the following weeks and months. Dr Knight reviews whether anything measurable has changed and advises on the next step, which may be a further PRP treatment, moving into an IVF cycle, or a frank conversation about a different path.
Ovarian rejuvenation: who is a candidate?
You may be considered for treatment if you:
- Have low or borderline AMH
- Have been diagnosed with diminished ovarian reserve
- Have been diagnosed with premature ovarian insufficiency or premature ovarian failure
- Have a raised FSH
- Are experiencing age related decline in ovarian function
- Responded poorly to stimulation in a previous IVF cycle
- Have had cycles cancelled because too few follicles developed
- Want to exhaust the options for using your own eggs before considering donor eggs
- Have been told by another clinic that donor eggs are your only remaining option
Who is unlikely to benefit
Being honest about this matters more than being encouraging. The treatment is unlikely to help if your difficulty conceiving has nothing to do with ovarian response, for example if the primary factor is tubal, uterine or male factor. It is not a treatment for unexplained infertility in a woman with normal ovarian reserve. And the further into established menopause a patient is, the less the published evidence supports expecting a meaningful result.
Suitability is a clinical judgement made after assessment, not something that can be settled from a webpage.
Ovarian PRP evidence and research: what the studies actually show
The 2024 systematic review
The most useful single piece of evidence is a 2024 systematic review published in the Journal of Ovarian Research. It examined 38 studies covering 2,256 women aged 18 to 55 with diminished ovarian reserve, premature ovarian failure or premature ovarian insufficiency. Its conclusion was that PRP treatment resulted in a statistically significant improvement in the main fertility parameters of women with diminished ovarian reserve.
That is a genuine finding across a reasonable body of work, and it is the strongest evidence currently available for this treatment.
What the evidence does not yet show
It is equally important to be clear about the limits. The studies in that review vary in size, design and quality. Most measure changes in fertility markers such as AMH and antral follicle count rather than live births. Improvement in a marker is a reasonable proxy for a better cycle, but it is not the same thing as a baby, and anyone who tells you otherwise is overselling.
There are also relatively few large randomised controlled trials in this field, which is the standard that would settle the question. This remains an emerging treatment, and Demeter presents it that way rather than as established practice.
Australian fertility clinics operate under the Reproductive Technology Accreditation Committee code of practice administered by the Fertility Society of Australia and New Zealand, and every treatment cycle performed in this country is reported to the national registry.
What results can you realistically expect?
In practice, the outcomes patients and clinicians look for fall into three groups.
The first is a change in markers. A rise in AMH or antral follicle count, or a drop in FSH, indicates the ovary is responding differently. This is the most commonly reported result and the easiest to measure.
The second is a change in cycle performance, which matters more. More follicles recruited during stimulation, more eggs collected, more mature eggs, more embryos available for transfer. A cycle that previously produced one egg producing three or four is a meaningful difference for someone with very limited reserve.
The third is the return of menstrual cycles in women who had stopped ovulating, which has been reported in some women with premature ovarian insufficiency.
Results vary substantially between individuals, and some women see no measurable change at all. That possibility is discussed openly before treatment.
Ovarian PRP success rates
There is no single honest success rate figure for this treatment, and you should be wary of any clinic that quotes one without qualification.
The reason is that outcomes depend heavily on who is treated. A 38 year old with borderline AMH and a history of one poor cycle is in a completely different position from a 46 year old with undetectable AMH, and averaging the two produces a number that describes neither. Published studies also define success differently, some by marker improvement, some by eggs retrieved, some by clinical pregnancy.
What Dr Knight can offer at your assessment is a view of your individual prospects based on your markers, your age, your history and hundreds of previous cases, rather than a headline percentage.
Is ovarian rejuvenation safe?
The safety profile is one of the more reassuring aspects of this treatment. Because the plasma is prepared from your own blood, there is no risk of rejection or of disease transmission from a donor.
The risks that do exist relate to the injection itself and are the same category of risk as an IVF egg collection: bleeding, infection, discomfort, and the small risks associated with anaesthesia. These are uncommon.
As with any surgical or invasive procedure there are risks, and Dr Knight will take you through them in full and answer your questions before you consent to treatment.
Ovarian rejuvenation cost in Australia
Demeter Fertility quotes individually rather than publishing a single price, because the cost depends on how many treatments your plan involves and whether the PRP is being combined with an IVF cycle.
Two points are worth stating plainly. The procedure is not covered by Medicare, so it is an out of pocket cost. And Demeter does not bulk bill.
Contact our team for a personalised quote. You will also get a clear view at your assessment of what Dr Knight expects the treatment to achieve for you before you decide whether to proceed.
How it compares to other approaches
Ovarian fragmentation
Ovarian fragmentation, sometimes called ovarian fragmentation for follicular activation, involves surgically removing a portion of ovarian tissue, fragmenting it and transplanting it back. Demeter performed this procedure for years before withdrawing it in favour of PRP, which is markedly less invasive and, on the available reports, more effective. You can read more about that transition and why it happened.
Stem cell therapy
Stem cell approaches to regenerating ovarian tissue are under investigation internationally. The science is interesting and the potential is real, but it remains experimental and is not offered at Demeter Fertility.
Donor eggs
Using donor eggs has substantially better and more predictable success rates than any attempt to improve your own ovarian response. For many patients it is the right answer, and our donor program exists for exactly that reason. Ovarian PRP is for patients who want to be certain they have exhausted the options for using their own eggs first, and for whom that certainty matters.
Supplements and lifestyle
There is no supplement proven to raise AMH or restore ovarian reserve. Some, such as CoQ10 and vitamin D where a deficiency exists, have a reasonable rationale for supporting general fertility. They are worth doing and they are not a substitute for treatment. Our guide to fertility supplements covers what the evidence supports.
How PRP and IVF fit together
For most patients this is not an alternative to IVF. It is something done before IVF to improve the conditions for the cycle that follows.
The sequence matters. PRP is generally scheduled far enough ahead of stimulation to give any effect on follicle development a window in which to occur. Dr Knight will map that timing out with you, including how many PRP treatments to have first and how the IVF protocol should be adjusted afterwards. Where time is the constraint, DuoStim double stimulation can be used to collect eggs twice within a single cycle.
One good egg
Underneath all of this is a principle that shapes how Demeter approaches low ovarian reserve. The goal is not the largest possible number of eggs. It is one good egg.
A cycle that collects twelve eggs of indifferent quality is not better than a cycle that collects three, one of which is genuinely good. For women with diminished ovarian reserve, chasing volume through aggressive stimulation often produces neither quantity nor quality, and it is hard on the patient. The purpose of the treatment, and of the protocols built around it, is to improve the quality of the response so that a cycle has a real chance of producing the one egg that works.
Where ovarian rejuvenation is performed
Ovarian rejuvenation at Demeter Fertility is performed at our Hurstville and Liverpool locations.
Hurstville: Suite 901, Level 9, Hurstville Plaza One, 288 Forest Rd, Hurstville NSW 2220. Phone 1300 899 850
Liverpool: Level 2/13 to 15 Moore St, Liverpool NSW 2170. Phone 1300 899 850
Patients travel to Dr Knight from across Australia and from overseas. Initial consultations are available by telehealth for interstate and international patients, so travel is only needed for the procedure itself.
Next steps
If you have been told your ovarian reserve is too low, or that donor eggs are your only option, an assessment with Dr Knight will give you a clear answer about whether this treatment is likely to help in your particular case. That answer may be no. If it is, you will hear it directly.
Read more about the ovarian rejuvenation program, or book an assessment.