Researchers at the Standford University School of Medicine identified a new technique to induce the ovaries of women suffering from Premature Ovarian Insufficiency (POI) to produce eggs. Using this technique, clinicians at the St. Marianna University School of Medicine in Kawasaki, Japan successfully collected mature eggs for in vitro fertilization from five of the twenty-seven women participating in an experimental study. One of these women has given birth to a healthy baby and another is pregnant.
The new technique has been coined “in vitro activation” or IVA and involves removing an ovary (or portion of an ovary), stimulating the ovary outside of the body, and then re-implanting the stimulated ovary near a woman’s fallopian tubes. The woman is then treated with hormones to stimulate the follicles.
According to the Mayo Clinic, premature ovarian insufficiency – also known as premature ovarian failure – refers to a loss of normal function of a woman’s ovaries prior to the age of 40. If ovaries fail, they do not produce normal amounts of estrogen or release eggs regularly, commonly resulting in infertility. Unlike woman suffering from premature menopause, women with POI may have irregular or occasional periods for years and may become pregnant, whereas women with premature menopause stop having periods and cannot become pregnant.
“Women with primary ovarian insufficiency enter menopause quite early in life, before they turn 40,” said Aaron Hsueh, PhD, professor of obstetrics and gynecology at Stanford and senior author of the study. “Previous research has suggested that these women still have very tiny, primordial primary and secondary follicles, and that even though they are no longer having menstrual cycles they may still be treatable. Our results obtained with our clinical collaborators in Japan make us hopeful that this is a group of patients who can be helped.”
“Human females have about 800,000 very small, primordial follicles at birth,” Hsueh said. “Most of them remain dormant, and only about 1,000 start to grow each month. One of these reaches maturity each month to produce an egg each menstrual cycle. It’s not known exactly how the follicles are selected for development, or why these follicles stop developing in women with primary ovarian insufficiency. But our treatment was able to awaken some of the remaining primordial follicles and cause them to release eggs.”
“For patients with primary ovarian insufficiency, egg donation is the only option for bearing a baby,” said Kazuhiro Kawamura, MD, PhD, associate professor of obstetrics and gynecology at the St. Marianna University School of Medicine and a lead author of the study. “These patients are eager to find a way to become pregnant with their own eggs,” Kawamura said. “I have collaborated with Dr. Hsueh since 2010, working on ways to wake up these dormant follicles. When I was successful in obtaining mature human eggs from large, developed follicles after blocking PTEN activity, I gained confidence that this approach could work clinically.”
Researchers are planning to expand this experimental treatment to include women that have lost their egg supply for any reason and speculate that it will take several years before IVA can become as routine of a procedure as IVF.
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