Early menopause: Baby born after ovaries 'reawakened'

A baby has been born through a new
technique to "reawaken" the ovaries of
women who had a very early menopause.
Doctors in the US and Japan developed the
technique to remove the ovaries, activate them
in the laboratory and re-implant fragments of
ovarian tissue.
The technique, reported in Proceedings of
the National Academy of Sciences, has
resulted in one baby being born with another
expected.
The findings were described as early, but a
"potential game-changer".
The 27 women involved in the study became
infertile around the age of 30 due to 'primary
ovarian insufficiency'. The condition affects
one in 100 women who essentially run out of
eggs too young, leading to an early
menopause.
Women have a fixed number of eggs at birth
and those with the condition tend to use them
up too quickly or are born with far fewer eggs
in the first place.

Wake-up
Eggs in the ovaries are not fully formed;
rather, they stay as follicles and some mature
each month.
The teams at Stanford University, US, and St
Marianna University School of Medicine, Japan,
were trying to activate the last few remaining
follicles, which may be present.
They removed the ovaries from the women and
used a combination of two techniques to wake
up the sleeping follicles. First they cut the
ovaries into fragments, which has been used in
the past as a fertility treatment. Then a
chemical to "take the brakes off" egg
development was applied.
The fragments were put back at the top of the
fallopian tubes and the women were given
hormone therapy.
Following the treatment, residual follicles
started to develop in eight women. Eggs were
taken for normal IVF and so far one couple
has had a baby and another woman is
pregnant.
Prof Aaron Hsueh, from Stanford, told the
BBC: "It has to be improved to figure out the
best way to do it, but we estimate it could
help 25 to 30% of the women.
"We think it could help in two other forms of
infertility. Cancer survivors after
chemotherapy or radiotherapy; if there's any
follicles left there's a chance this will help.
"And also women aged 40 to 45 with an
irregular menstrual cycle."

Major interest
The implications for women with early
menopause are still unclear as the technique
will require further testing and refinement
before it could be used in clinics.
Prof Charles Kingsland, from Liverpool
Women's Hospital and the Royal College of
Obstetricians and Gynaecologists, said: "It's
really clever, but will it work for everyone? We
don't know.
"It's potentially really, really, interesting, but
we need a lot more investigation to confirm
this is not another false dawn.
"I will see primary ovarian insufficiency on a
regular basis in my clinic so if it's effective in
the long term, it's something we'd be
interested in."
Prof Nick Macklon, from the University of
Southampton, told the BBC: "Finding a new
way to get new eggs by waking up sleeping
follicles is very promising. It's potentially a
game-changer.
"It's a very important and very exciting piece
of science, but it is not ready for the clinic. It
still needs good randomised control trial
data."
He added that performing the technique
outside of a research study would be
unfeasible, but a deeper understanding of the
mechanisms of egg development could lead to
new medications.