Early menopause: a Japanese study opens the door to new and concrete hopes of pregnancy

A new window opens for those who have seen their dreams collapse due to a diagnosis of early menopause, which leaves no hope of pregnancy unless linked to egg donation .

Starting from puberty, our ovaries begin to mature follicles, every month only one (apart from some rare cases of pluriovulation responsible for heterozygous twins) reaches complete maturation, releasing the egg cell at the time of ovulation.

And this is repeated cycle after cycle until menopause.

There are women who begin to experience the symptoms of menopause before the age of 40 , in these cases we speak of primary ovarian insufficiency. These women have few follicles remaining and the only way to have a baby is with assisted reproduction through egg donation.

Now the researchers led by prof. Kawamura of the St. Marianna University School of Medicine in Kawasaki demonstrated that it is possible to activate remaining follicles in vitro and then graft reactivated ovarian tissue into patients to obtain mature egg cells . These mature egg cells are then harvested and fertilized in vitro. Thanks to this technique, the first case of a baby born alive thanks to this treatment was documented.

The research marks a truly important turning point in this field and is published in the authoritative scientific journal PNAS ( Proceedings of the National Academy of Sciences) . It is the result of collaboration with the Stanford University in particular with Aaron Hsueh, professor of obstetrics and gynecology.

This technique has been called IVA, in vitro activation , and does nothing but stimulate the follicles to produce mature egg cells which can then be fertilized by sperm.

Females of our species are born with approximately 800,000 primordial follicles. Most of them remain dormant and only about 1,000 start growing each month. Only one of these per menstrual cycle reaches maturity to be able to release the egg cell once a month.

Although it is not yet known exactly how follicles are selected for maturation, or why these follicles stop developing in women with primary ovarian failure, the method devised by the researchers was able to awaken some of the remaining follicles. primordial inducing them to release egg cells.

The research involved 27 women (average age 37 years m average 6-8 years without menstruation) with primary ovarian insufficiency, who underwent a slightly invasive procedure to remove both ovaries

Among the 27 women, 13 ovaries were found to have residual follicles.

The ovarian tissues were fragmented and then the treated tissues were reimplanted near the fallopian tubes.

The researchers then monitored the women with weekly or biweekly ultrasound scans and hormone measurements to detect follicle growth. Follicle growth was found in eight of the thirteen women, who were then treated with hormones to stimulate ovulation.

Of these women , five developed mature eggs which were then collected for the VAT . The eggs were fertilized with the partner’s sperm and the four-cell embryos were frozen before being transferred to the uterus.

Of the five women, one woman received an embryo but did not become pregnant. Two women are preparing for embryo transfer or undergoing extra rounds of egg collection.

One woman received one embryo and is pregnant , while another received two embryos and gave birth to a healthy baby .

Dr. Kazuhiro Kawamura, associate professor of obstetrics and gynecology and lead author of the study released this statement:

“ Although I believed, based on our previous research, that this IVA approach would work, I monitored the pregnancy closely and, when the baby was in breech presentation, performed the C-section myself… I could not sleep at night.” before the operation, but when I saw the healthy baby, my anxiety turned into happiness. We hugged in tears with the parents. I hope that the IVA will be able to help patients with primary ovarian failure around the world .”

Currently researchers are trying to understand if this method could also be applied to women who have other fertility problems, such as those with early menopause caused by cancer, chemotherapy or radiation, and for those who are no longer fertile in the age group between u 40 and 45 years old.

Prof. Hsueh is also evaluating other ways to avoid exporting the ovaries to proceed with local activation through specific drugs, but this will take time.