Tuesday, 25 April 2017

Pregnancy after the menopause

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New Scientist

April 1, 2017

Pregnancy after the menopause


LENGTH: 726 words
Exclusive: menopausal women become pregnant with their own eggs
Two women conceived with their own eggs after experimental therapy

Jessica Hamzelou
TWO women thought to be infertile have become pregnant using a technique that seems to rejuvenate ovaries.
It is the first time such a treatment has enabled women with menopause symptoms to get pregnant using their own eggs. "I had given up hope on trying to get pregnant," says one of the women, WS, who is now six months pregnant. "To me, it's a miracle."
The approach uses a person's own blood, isolating platelet-rich plasma, which has a large number of the cell fragments usually involved in clotting. Konstantinos Sfakianoudis and his colleagues 
at the Genesis Athens Clinic in Greece are using this plasma in 
an attempt to repair women's reproductive systems, injecting 
it directly into the ovaries and uterus. So far, the team has given this experimental therapy to more than 180 women, many of whom sought treatment because they have a disorder that damages the lining of the uterus.
But the team has also given the treatment to 27 menopausal and peri-menopausal women between the ages of 34 and 51. Some had treatment because they wanted to stop symptoms of the menopause, but most did it because they wanted to get pregnant. Eleven of these women have since had IVF, and two women have managed to get pregnant. WS, a 40-year-old from Germany, had been trying to get pregnant for more than six years. "The doctor said I was peri-menopausal," she says. "After the sixth IVF, the doctor said we should stop there, and consider egg donation."
WS received treatment at the Genesis Athens Clinic, then had standard IVF treatment in Germany, which prompted her to release three eggs. The highest quality egg was fertilised, and an embryo was implanted in her uterus. "Everything is going well," she says. "It's a girl".
The other woman, a 39-year-old from the Netherlands, had not had a period for four years, and had been showing other signs of menopause. She had treatment at the clinic in December 2016. A month later, she began menstruating again, says Sfakianoudis.
High hopes
However, she miscarried last week, a few months into her pregnancy. Women between the ages of 35 and 39 have around a one in five chance of miscarriage during the first 12 weeks. "Even with the miscarriage it's extremely encouraging," says Sfakianoudis. He hopes she will try again.
Doctors say the results seem promising, but rigorous trials are needed before drawing conclusions. "Anything that might help ovaries regain function would be fabulous," says John Randolph at the University of Michigan in Ann Arbor. "A lot of people have high hopes of doing something like this."
The team isn't sure how the treatment might be working. The plasma may awaken stem cells in the ovary, encouraging them to make eggs, but there is debate over whether such stem cells exist. Or the plasma itself may contain stem cells, says Randolph. "We need to figure out how this works and how safe it is," he says.
Simply sticking a needle into an ovary might have an effect, says Claus Yding Andersen at Copenhagen University Hospital in Denmark. Damaging an ovary can change the shape of its blood vessels, which may cause isolated egg follicles to be provided with 
a blood supply for the first time, enabling them to release eggs.
Sfakianoudis is planning a clinical trial in Greece and the US, comparing the plasma with a placebo injection. Until then, it is impossible to say how well the treatment is working, if at all, says Kutluk Oktay at New York Medical College. Even once menopause starts, some egg follicles remain, so there is a small chance that women can still get pregnant without any intervention, he says.
If it works, the treatment 
would be particularly welcome 
to the 1 per cent of women who experience menopause before the age of 40. Menopause usually occurs around the age of 50, and so far, Sfakianoudis's team has not treated anyone over 52. He says it is not his place to judge how old is too old to start a family.
But pregnancy is riskier in older age, says Andersen. "I do think it's questionable whether we should allow women in their 60s and 70s to get pregnant," he says. n
-Fresh fertility-
"Anything that may help ovaries function again would be great. Many have high hopes of doing this"