THIS WEEK
A blood treatment seems to restore periods and fertility to menopausal women. Is it too good to be true, asks Jessica Hamzelou
MENOPAUSE
need not be the end of fertility. A team claims to have found away to
rejuvenate post-menopausal ovaries, enabling them to release fertile
eggs, New Scientist can reveal.
The
team says its technique has restarted periods in menopausal women,
including one who had not menstruated in five years. If the results hold
up to wider scrutiny, the technique may boost declining fertility in
older women, allow women with early menopause to get pregnant, and help
stave off the detrimental health effects of menopause.
"It
offers a window of hope that menopausal women will be able to get
pregnant using their own genetic material," says Konstantinos
Sfakianoudis, a gynaecologist at the Greek fertility clinic Genesis
Athens.
"It
is potentially quite exciting," says Roger Sturmey at Hull York Medical
School in the UK. "But it also opens up ethical questions over what the
upper age limit of mothers should be."
Women
are thought to be born with all their eggs. Between puberty and the
menopause, this number steadily dwindles, with fertility thought to peak
in the early 20s. Around the age of 50, which is when menopause
normally occurs, the ovaries stop releasing eggs - but most women are
already largely infertile by this point, as ovulation becomes more
infrequent in the run-up. The menopause comes all-too-soon for many
women, says Sfakianoudis.
The
age of motherhood is creeping up, and more women are having children in
their 40s than ever before (see graph, below). But as more women delay
pregnancy, many find themselves struggling to get pregnant. Women who
hope to conceive later in life are increasingly turning to IVF and egg
freezing, but neither are a reliable back-up option (see "The pregnancy
pause", page 30).
The
menopause also comes early-before the age of 40-for around 1 per cent
of women, either because of a medical condition or certain cancer
treatments, for example.
To
turn back the fertility clock for women who have experienced early
menopause, Sfakianoudis and his colleagues have turned to a blood
treatment that is used to help wounds heal faster.
Platelet-rich
plasma (PRP) is made by centrifuging a sample of a person's blood to
isolate growth factors - molecules that trigger the growth of tissue and
blood vessels. It is widely used to speed the repair of damaged bones
and muscles, although its effectiveness is unclear. The treatment may
work by stimulating tissue regeneration.
Sfakianoudis's
team has found that PRP also seems to rejuvenate older ovaries, and
presented some of their results at the European Society of Human
Reproduction and Embryology annual meeting in Helsinki, Finland, this
month. When they injected PRP into the ovaries of menopausal women, they
say it restarted their menstrual cycles, and enabled them to collect
and fertilise the eggs that were released.
"I
had a patient whose menopause had established five years ago, at the
age of 40," says Sfakianoudis. Six months after the team injected PRP
into her ovaries, she experienced her first period since menopause.
Sfakianoudis's
team has since been able to collect three eggs from this woman. The
researchers say they have successfully fertilised two using her
husband's sperm. These embryos are now on ice - the team is waiting
until there are at least three before implanting some in her uterus.
The
team isn't sure how this technique works, but it may be that the PRP
stimulates stem cells. Some research suggests a small number of stem
cells continue making new eggs throughout a woman's life, but we don't
know much about these yet. It's possible that growth factors encourage
such stem cells to regenerate tissue and produce ovulation hormones.
"It's biologically plausible," says Sturmey.
Fertilised eggs
Sfakianoudis's
team says it has given PRP in this way to around 30 women between the
ages of 46 and 49, all of whom want to have children. The researchers
say they have managed to isolate and fertilise eggs from most of them.
"It
seems to work in about two-thirds of cases," says Sfakianoudis. "We see
changes in biochemical patterns, a restoration of menses, and egg
recruitment and fertilisation." His team has yet to implant any embryos
in post-menopausal women, but hopes to do so in the coming months.
PRP
has already been helpful for pregnancy in another group of women, says
Sfakianoudis. Around 10 per cent of women who seek fertility treatment
at his clinic have a uterus that embryos find difficult to attach to -
whether due to cysts, scarring from miscarriages or having a thin
uterine lining. "They are the most difficult to treat," says
Sfakianoudis.
But
after injecting PRP into the uteruses of six women who had had multiple
miscarriages and failed IVF attempts, three became pregnant through
IVF. "They are now in their second trimester," says Sfakianoudis.
Fertility
aside, the technique could also be desirable for women who aren't
trying to conceive. The hormonal changes that trigger menopause can also
make the heart, skin and bones more vulnerable to ageing and disease,
while hot flushes can be very unpleasant. Many women are reluctant to
take hormone replacement therapy to reduce these because of its link
with breast cancer. Rejuvenating the ovaries with PRP could provide an
alternative way to boost the supply of youthful hormones, delaying
menopause symptoms.
However,
Sfakianoudis's team hasn't yet published any of its findings. "We need
larger studies before we can know for sure how effective the treatment
is," says Sfakianoudis.
Some
have raised concerns about the safety and efficacy of the procedure,
saying the team should have tested the approach in animals first. "This
experiment would not have been allowed to take place in the UK," says
Sturmey "The researchers need to do some more work to make sure that the
resulting eggs are OK," says Adam Balen at the British Fertility
Society.
To
know if the technique really does improve fertility, the team will also
need to carry out randomised trials, in which a control group isn't
given PRP.
Virginia
Bolton, an embryologist at Guy's and St Thomas' Hospital in London, is
also sceptical. "It is dangerous to get excited about something before
you have sufficient evidence it works," she says. New techniques often
find their way into the fertility clinic without strong evidence, thanks
to huge demand from people who are often willing to spend their life
savings to have a child, she says.
If
the technique does hold up under further investigation, it could raise
ethical questions over the upper age limits of pregnancy- and whether
there should be any. "I lay awake last night turning this over in my
mind," says Sturmey. "Where would the line be drawn?"
Health
issues like gestational diabetes, pre-eclampsia and miscarriage are all
more common in older women. "It would require a big debate," says
Sturmey.
Older mothers
The percentage of women giving birth in England and Wales who are 40 or older has quadrupled since 1980
Never too old?
More eggs, please
~~~~~~~~
By Jessica Hamzelou
