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Ovaries 'reawakened' and baby born to early menopause mother

7 October 2013
Appeared in BioNews 725

A new treatment to stimulate egg production from post-menopausal ovaries has resulted in the successful birth of a child after testing in a small clinical trial.

Along with the 26 other women in the study, published in the journal PNAS, the new mother had primary ovarian insufficiency (also known as premature ovarian failure), a condition which leads to an early menopause.

Speaking to the BBC, senior study author Professor Aaron Hsueh of Stanford University in the USA, said the new technique, called in vitro activation (IVA), still needed to be refined but could help 25 to 30 percent of women with primary ovarian insufficiency.

'We think it could help in two other forms of infertility', he added, 'cancer survivors after chemotherapy or radiotherapy […] and also women aged 40 to 45 with an irregular menstrual cycle'.

IVA is not likely to be applicable to conventional menopause, however.

In the technique, an ovary (or a portion of an ovary) is removed from the patient, treated outside the body and then re-implanted near her fallopian tubes. The ovaries are then stimulated to produce eggs with hormone treatments. The woman is then treated with hormones to stimulate the growth of specialised structures in the ovaries called follicles in which eggs develop.

In primary ovarian insufficiency, which affects about one percent of women of reproductive age, the fixed number of ovarian follicles that women are born with is lower than usual, or eggs are released more often, causing onset of infertility before the age of 40 as the eggs run out.

However, 13 participants in the study were found to have ovarian follicles that contained an immature egg before IVA treatment. The aim of the treatment was to 'reawaken' these follicles. After IVA treatment, follicle growth was detected in eight patients, five of whom produced mature eggs that were collected and used for conventional IVF. One child has so far been born following the procedure and another woman is pregnant.

IVA addresses two cell signalling pathways discovered in mouse ovaries, one that prevents follicle maturation and one that promotes it.

Reaction from experts not involved in the study has been positive, if cautious. Professor Charles Kingsland, of the Royal College of Obstetricians and Gynaecologists, said: 'It's really clever, but will it work for everyone? We don't know... we need a lot more investigation to confirm this is not another false dawn'.

Similarly, Professor Nick Macklon, from the University of Southampton, told the BBC the technique was 'potentially a game-changer'.

'It's a very important and very exciting piece of science, but it is not ready for the clinic', he confirmed. 'It still needs good randomised control trial data'.

SOURCES & REFERENCES
Early menopause: Baby born after ovaries 'reawakened'
BBC News |  30 September 2013
Hippo signaling disruption and Akt stimulation of ovarian follicles for infertility treatment
Proceedings of the National Academy of Sciences (PNAS) |  30 September 2013
Hope for infertile women: Pioneering operation reawakens ovaries in women who've had early menopause
Daily Mail |  30 September 2013
Stanford-developed technique induces egg growth in infertile women, and 1 gives birth
EurekAlert! (press release) |  30 September 2013
Women given hope of post-menopause babies
Daily Telegraph |  30 September 2013
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