Welcome to another episode of the Egg Whisperer Show. This might be the most excited I’ve been interviewing somebody. I’ve wanted him on the show for a long time. I have Dr. Zaher Merhi on today’s show, and we will be talking about At-Home IVF, PRP Ovarian Rejuvenation, and Ozone Sauna Therapy Therapy. Dr. Merhi is a fertility specialist at Dr. Merhi is the founder and the medical director of Rejuvenating Fertility Center (RFC).
Dr. Aimee: Welcome to the show, Dr. Merhi. I look up to you. Thank you for all you do, teaching future generations of fertility doctors. That’s awesome.
Why did you go into medicine, and more specifically fertility medicine?
Dr. Zaher Merhi: Well, honestly, the OBGYN field always was amazing. When I was finishing my residency, I had to choose between gynecology, oncology, and fertility. When I was doing the oncology part, even though I liked the surgery part, at the end you lose patients and you get attached to them, so it was a little bit depressing to me because I got to know the patients and it’s sad when you lose them. That’s why I liked a happy ending, having babies, I think it’s an amazing thing. Everybody around me, friends, family, they all did IVF at some point, so I feel like I was naturally born for this.
Dr. Aimee: Yes. I do believe it was in my DNA as well, so we can definitely relate with that. You are the founder and inventor of At-Home IVF. Can you tell us, what is it?
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Dr. Zaher Merhi: People think I’m crazy. No, I’m not. People are like, “How can you do IVF without monitoring?” First, we need to know what’s in the kit before we jump to conclusions.
In the conventional IVF, people take shots, so there’s a risk of ovarian hyperstimulation syndrome with a lot of eggs and that can be severe and deadly. But with the At-Home IVF kit, there are zero shots, so really there is no reason to monitor and there is no risk for the patient’s life or anything like that. So, I’m not crazy, number one.
Number two, it has no needles. Patients who are afraid of shots, and I can tell you one of the main reasons why I came up with this is because I’m afraid of the shots. I can show you videos of nurses making fun of me when I take the flu shot every year, they literally have to pin me in the corner to give me the flu shot. There’s no shots, so that’s amazing.
Number three, because there is no risk of hyperstimulation, you really don’t need to come to the office to monitor. It’s ideal for the COVID-19 era where this kit, we take history from you as a patient, a lot of patients have done IVF somewhere else, so we tell them to send us everything. First, we want to have a clear picture to make sure that the patient is safe and healthy to undergo IVF.
Once we have all the records, we will send the kit to the patient’s house. The patient will start on the third day of her cycle with the pills, which mostly are Clomid and Letrozole combination. It could be one pill of each, two pills of each, or three pills of each. Then around day eleven or twelve, the patient will take nasal spray instead of Lupron trigger shot or other drug. Then she comes just on the day of the egg retrieval. It is amazing.
Now, I want to make it very clear that it works beautifully for patients who have a regular cycle and beautifully for patients who have PCOS. But women with very low ovarian reserve, it might not work for them very beautifully, especially those who have irregular period. If you think about it, most patients ovulate on day fourteen, so you usually bring them back on day thirteen after the trigger shot, you’re going to get eggs on 90% of patients. People are like, “You’re not going to get a lot of eggs.” True, but guess what? You get a lot of embryos.
I have to tell you — I do believe that the less stimulation you get, the better quality eggs. I’ve seen that.
We have a patient that did At-Home IVF during the COVID-19, which is still now, her name is Omolola, and the reason why I’m saying her name is that she gave me the permission and signed a consent to allow me to talk about her experience. We did the At-Home IVF kit, we got eight eggs and four blastocysts. That’s amazing. She did not take any shots.
To me, it’s amazing. If it works, great. If it doesn’t work, at least you’re trying during the COVID-19 quarantine in order not to waste a month. If it works, that’s great. If it doesn’t work, don’t pay for the kit, we’re not going to charge you for the kit.
Dr. Aimee: You just answered my question beautifully of who is it for. Do you do an ultrasound before you do the retrieval to know if that patient should go through the retrieval or not?
Dr. Zaher Merhi: Absolutely. We do blood and ultrasound the day of. I’ll tell you, maybe 5% of patients, or less than 5%, they ovulate, and maybe a couple of percent they did not take the nasal spray properly, so they did not trigger and we don’t get eggs, because even though the follicles are there, the trigger shot did not really work for them very well. So, that’s why I always tell patients that it works 90% of the time, 95%, but not for everybody. This is how it works.
Dr. Aimee: The reason why I love this approach and the reason behind it is so many women are counseled or told to freeze their eggs by the time they’re 25. You and I both know that those shots can really cause a lot of discomfort and pain, and it can take a while to recover from that. A very simple approach like what you described can be a solution.
A young woman doesn’t really need more than eight to ten eggs frozen for themselves when they’re going through egg freezing. I can tell you that if my daughter was going through egg freezing at the age of 20 to 25, this would be an approach that I would want her to consider using.
I like to do IVF as pain-free. I wish I could needleless IVF and not have to monitor levels with shots and blood draws. This is a great solution.
You mentioned being able to get with that patient that gave you consent to talk about her story, eight eggs and several embryos. What about pregnancies?
Dr. Zaher Merhi: Her embryos are right now being run for genetic testing, so I’m not going to lie to you and tell you she’s pregnant. I don’t want to jump to conclusions. I really think she’s going to get pregnant with four blastocysts, so I want to give you an update on the patient as we move along.
We have a lot of patients, she’s not the only one. The reason why I’m talking about her in particular is because she gave me the consent because she was so excited, she wanted her story to be told to other people.
One other thing that I’d also like to mention is if patients are afraid of blood draws, they want still to monitor, we do the saliva and urine testing instead of doing blood. We do the FSH and LH hormone in the urine, and estradiol and progesterone in the saliva. That also is an alternative for people who are afraid of the blood draws. That’s a separate story, but I’m just saying we can still accommodate patients who are afraid of needles.
Dr. Aimee: That’s amazing. I tell patients I design treatment cycles as if it were happening to me. I love how you’ve basically done the exact same for your patients, and you don’t have a uterus. I love it.
Dr. Zaher Merhi: I get moody sometimes, like PMS.
Dr. Aimee: I want to transition now to something else that is very popular out there, patients talk to me a lot about it. I figure you are the very best person to talk about it. That is PRP Ovarian Rejuvenation. What is it?
Dr. Zaher Merhi: I’m going to tell you a little bit of the history of the PRP Ovarian Rejuvenation before I come to the conclusion as to why I decided to actually perform it on patients. I don’t like to do anything that makes patients pay without me counseling her properly as to why I’m doing it.
Now, the PRP, or platelet rich plasma, it’s patient’s own blood. They take blood from the patient, a couple of tubes, extract the platelets and the plasma. It started over a decade ago, being used by athletes for joint injuries and muscular skeletal problems, like Tiger Woods. They have PRP for their knees and their ankles, and all of that.
Then it evolves. Now it’s used for so many things. It’s used for hair loss. I’ve had a lot of patients who I saw it where they came with thin hair, and then they come back after the PRP and are like, “I did PRP on my scalp.” It’s used for vaginal rejuvenation, for facial rejuvenation, so many things, diabetic foot ulcers, some dentists now are using it.
Five years ago, a group in Greece, we have to give them credit, they started to give it in the ovaries of women who had very low ovarian reserve. I thought they were crazy in the beginning. Then they started to publish women who have menopause and premature menopause, one of them actually was 46 years old, and got pregnant after PRP. What they did was take blood, extract the PRP, they go vaginally and inject the PRP inside the ovaries.
Why and how does it work? There are two mechanisms. Mechanism number one, the PRP, or the platelets and the plasma, have a strong growth factor. Remember, there are protocols still now used which involve human growth hormone, which is a growth factor that patients take. That multiplied by a thousand, you’re basically taking the patient’s own growth factors and putting them inside the ovary.
If a patient is menopausal, she has no eggs. No. A lot of people think she has no eggs, but that’s not true. Aimee and I know that women post-menopause still have around 1,000 eggs that are dormant inside their ovaries. That’s established, I’m not saying anything new. The PRP stimulates some of those follicles to just wake up and then we can collect them. That’s mechanism number one.
Mechanism number two is debatable, but some scientists think that the ovaries have something called ovarian stem cells. These stem cells are cells that don’t have a function yet. The PRP, when you stimulate them, they wake up and they get a function, they can turn into younger eggs or younger follicles.
Scientists are debatable on this, but that’s the only way that explains why someone who has no period now are after the PRP getting good quality eggs and they’re getting pregnant. Does it work for everybody? No. Can I tell you before I meet you if it’s going to work for you or not? No. You have to try it first.
Before the PRP, what I used to do was I used to do modified ovarian rejuvenation, which is I go in and just puncture the ovary with no PRP. I thought in the beginning the PRP is going in the blood anyway and going to the ovaries, why do I need to take them out and inject them. I thought it’s the fact that you’re puncturing the ovary, causing bleeding, that increases blood flow and growth factors. I was partially right, but the studies that came up in 2019 really convinced me that the PRP itself is adding a huge value to the ovarian response.
There’s a group at the ASRM, which is our annual meeting in Philadelphia in 2019, I can’t remember who, but the very recent researcher and scientist, one of the people on the abstract, they looked at 152 women before and after PRP and they showed that the number of follicles almost tripled, the number of FSH went down, AMH went up, they had double the number of eggs, and almost 40% increase in embryos formation, and they were all low ovarian reserve.
Then there are other studies that they took follicles of women, put them in a dish in the lab, added PRP, and they showed before and after.
All of these studies convinced me that it might work. That’s why I started doing it. I want to make it very clear that I’ve had patients three years ago begging me to do it and saying they’d pay $10,000, and I said no. I don’t feel comfortable doing something unless I have evidence for it, because I’m an evidenced-based guy.
That’s the history of the PRP and the way it works.
Dr. Aimee: Who is it specifically for? Who do you think is the best candidate for it? Is it the 46-year-old woman or is it the 39-year-old with low ovarian reserve?
Dr. Zaher Merhi: This is a great question. I don’t know. I’m not going to lie to you. I’ve noticed, believe it or not, that some of the women in their 40s did better than women who have premature ovarian insufficiency. You know why? Because the premature ovarian insufficiency, which are menopause before the age of 40, and they’re usually young, for some reason they might have some genetic issues that probably predispose them to respond less to the PRP. Again, I do not have evidence for this. I am guessing in my head and I’m thinking out loud.
Back to your question. Anybody can do the PRP. I’ve had patients who had bad quality eggs and have much better quality eggs following the PRP. Whether the PRP is working like a human growth hormone, that’s given in a lot of protocols, is actually plausible. It does make sense, because we know how human growth hormone does work for women with low ovarian reserve or poor egg quality.
Also, I’m doing it for women who are even late-40s. A patient, I cannot mention her name, but a 47-year-old. She’s not from New York. She came to me and she had no period for six months. She did the PRP. Went to her home state, had sex two weeks after the PRP, and got pregnant. Do you know why? I can’t even tell you. She’s one of the nicest patients and everybody was excited.
But I’ve had patients that were much younger than her that it didn’t work for them. It seems there is some genetic factor. It’s like Coronavirus, no one knows who it is killing, they say there is race and genetics. Same thing, it’s really hard for me to tell. I always tell people you need to try it. If it works for you, great. If it doesn’t work for you, I want to make it very clear from the beginning that it’s a 50/50 chance, I think, for it to work.
Dr. Aimee: So, you’ve actually seen success in women over the age 45 have a healthy pregnancy?
Dr. Zaher Merhi: One so far with the PRP. She had intercourse. She didn’t even do IVF.
Dr. Aimee: The likelihood of a 47-year-old getting pregnant is like 0.0001%. It’s so low. That’s a pretty incredible story. I admit, I think of it as a scam, I think of it as totally crazy, but then I did go to GoDaddy.com and bought every PRP website, IVFPRP.com, no joke. I researched how to do PRP in my own office. After reading the Greek studies, I think they reported like one out of 800 cases was positive and there were three pregnancies, only one live birth, and the one live birth was still having regular periods. Something like that, don’t quote me on that. I didn’t feel like it was fair to offer it to women knowing that.
Maybe I’ll change my mind, because hearing you talk about all the research you did before you decided to offer it, especially the story about the 47-year-old woman, I definitely don’t want to mislead or misguide people, but it might be something for patients to call you about. Let’s say a patient of mine wants to reach out to you. Would that be possible if I wanted to send them your way?
Dr. Zaher Merhi: Absolutely. I agree with you that maybe this woman who did the PRP at 47 and got pregnant, maybe she could have gotten pregnant by herself without doing the PRP. This is a maybe. I do believe in evidence-based medicine. I do believe that we need an answer by doing trials and more basic science research.
We are currently doing basic science research on PRP. We’re taking granulosa cells from women undergoing IVF, splitting them in half, treating one with control, one with PRP, in order to look at steroidogenic enzyme genes that produce estrogen and all of that. Because I want to know myself mechanistically how PRP works.
But, yes, I’m more than happy to help patients of yours who are interested in the PRP.
Dr. Aimee: Awesome. Can you tell us a little bit about the patient experience when they’re doing it? How does it feel? Are they asleep for it? For people who want to know.
Dr. Zaher Merhi: It’s a two-hour procedure. The patient comes in without food or drink in the morning, we take the blood, we process the PRP. It takes like an hour and a half, she’ll be waiting in the lobby. After an hour and a half, we take her to the procedure room, our anesthesiologist will give her propofol, which is a very light sedation, so she won’t feel the poking. Then, like an egg retrieval, instead of sucking the egg, now I’m injecting PRP inside her ovaries. The injection procedure itself takes 10-15 minutes
Dr. Aimee: About how many punctures in each ovary are you making?
Dr. Zaher Merhi: I try to do between five and ten. I try to distribute the PRP all over the cortex area of the ovary, because this is where the eggs are. I try to increase exposure to the eggs as much as possible.
Dr. Aimee: The next thing I want to talk to you about is Ozone Sauna Therapy. It sounds like going to a spa. What is that all about?
Dr. Zaher Merhi: It is like a spa. It’s actually a very comfortable machine. You go naked into it, and then you cover yourself, so only your head is coming out. The ozone flows throughout your body. There’s small tiny hose that a patient puts vaginally and it infuses the ozone in the vaginal area as well.
We have studies on this. We’ve done preliminary study on patients without charging them anything the first six months before we started to implement, so I want to make it very clear as well.
Ozone is like the oxygen that we breathe. The oxygen that we breathe is two oxygen molecules. The ozone is a third oxygen molecule. The ozone layer is the layer that covers the Earth from the UV light and all that stuff and protects the Earth.
Ozone therapy has been used since World War I. This is not something new. They used to sterilize the instruments that did surgeries with back in the day with ozone, because ozone is a very powerful antibacterial, antiviral, antifungal, anti-whatever-you-want-to-do.
The ozone also works as an anti-inflammatory agent, it lowers body inflammation. It’s used for a lot of inflammatory disorders. It’s given rectally for women with Ulcerative Colitis. I have patients who have done that before.
By the way, a patient told me about the Ozone Sauna Therapy. I didn’t know what it was a few years ago, just a disclaimer.
Patients with arthritis inject it the ozone with a needle inside their knee. Dermatologists use it for psoriasis and eczema and stuff like that. So, it does have a lot of multiple uses. We were the first to use it for fertility. A patient came to me three years ago and she told me, “Why don’t you do ozone for your patients?” I was like, “What is ozone therapy?”
Then actually I started to read about it. Then what we did is we looked at patients before and after ozone. The session is half an hour, it’s actually very relaxing. Your body becomes warm and you sweat a lot. Patients do a half hour session twice a week for around three weeks, which is a total of six sessions.
Then what we did is I looked at a cohort of women who had very low ovarian reserve. Before ozone, they did IVF, which is cycle one, they did ozone for three weeks, then they did IVF cycle two. I compared the outcome of cycle two to cycle one. They actually had a similar number of eggs, but after the ozone they did significantly more embryos compared to before.
This tells me that it did do something good to the egg quality that potentially could improve outcome. We’re still doing studies on basic science. Again, I’m having granulosa cells put in the ozone machine before and after. I was supposed to present back in October at Vancouver and SRI. I had my presentation accepted, but unfortunately the meeting was canceled because of the COVID-19.
We are continuing our research. I have a PhD student who her topic is ozone, because she actually got pregnant only on ozone, so it’s personal to her.
Also, it’s used for women with thin lining. Ozone is a very powerful vasodilator, it increases blood flow to the uterus. We did publish a study, you can look it up on PubMed, regarding a small case series of women whose lining was so thin, you’re talking about three to four millimeters, they were told, “You’ll never get pregnant. You need a surrogate or a gestational carrier.” They did ozone and two of them got pregnant.
The reason why we’re doing these things, the PRP and ozone, is because if we don’t do something different, first of all, science is not going to move forward. I feel like it’s enough, everybody does the same thing, conventional IVF. I think it’s time to do something outside the box, because everybody is different. We’re trying to individualize IVF, we’re trying to make it more patient-friendly.
Also, our focus is mainly women with low ovarian reserve, because a lot of women are waiting, because women are very successful and they’re busy. Some people cannot have money right now to freeze eggs, so, yes, it’s sometimes too late for some. Those patients, I think we need to do something experimental for them in order to increase their chances of having a baby using their own eggs.
Dr. Aimee: That’s awesome. Is ozone something that people should consider doing prophylactically or as a preventive measure? I’m just thinking out loud. Or something that they should meet with you, get some information about their fertility levels, and then you incorporate it into their treatment?
Dr. Zaher Merhi: I recommend it for patients who have poor IVF outcome. As far as recommend it to everybody, I don’t think that’s ethical to make people pay for something that’s not really recommended. I really would like to use it for patients that are difficult cases where I ran out of everything, like I want to do something else hoping to help them. So, yes, I’d like to have a consultation, talk to the patient first, and on a case by case basis.
I’m also interested in looking at Ozone Sauna Therapy and endometriosis pain, because endometriosis is an inflammatory process and a lot of women have that. Ozone is anti-inflammatory. I’ve had a patient who has endometriosis and by chance she told me her pain got less when she did the ozone. This is how I’m thinking we should really start to study ozone and endometriosis. I also would like to see if it shrinks fibroids. But, step by step.
Dr. Aimee: Right. I love your passion. I love what you’re doing. I love how you’re being so creative for your patients. I can only imagine how much your patients love you. Thank you for all the work that you’re doing.
Tell us again where patients can find you, tell us about your clinic, your website, where you are, all that kind of stuff.
Dr. Aimee: Thank you for everything. Thank you everyone for watching today’s show. Join us next time. Have a great day.
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