preservation

Can menopause be reversed with stem cells?

Restoring fertility with stem cells: Princeton IVF blog
New research suggests bone marrow stem cells could be used restore estrogen and fertility in women with early menopause.

It may become possible in the near future

Women who suffer from premature menopause, also known as primary ovarian insufficiency (POI) or primary ovarian failure (POF) have either run out of eggs or no eggs capable of being stimulated.

This can occur for a number of reasons but early menopause causes 2 major problems for women who suffer from it. One is infertility, and this type of infertility can usually only be successfully treated with donor egg IVF. The other problem is hormonal. With the depletion of ovarian follicles, levels of reproductive hormones, especially estrogen, drop dramatically. The low levels of estrogen can cause a number of problems including vaginal dryness, difficulty with intercourse, hot flushes, bone loss and loss of sleep to name a few.

So, if there was a safe way to restore eggs to an ovary that has shut down prematurely, it might be a great advance in women's health care.

With that in mind, the ROSE trial was undertaken. The researchers injected cells from the bone marrow, which is rich in stem cells into the ovaries in an attempt to help regenerate new eggs.

Obtaining cells from the bone marrow is a fairly routine medical procedure and injecting substances into the ovarian is also not a new procedure. What is new about this is combining the two and using stem cell to restore ovarian function.

The few patients in the trial had an increase in the size of their ovaries and higher estrogen levels even a year out of from the procedure.

It will still take time and more studies to determine how safe and effective stem cells from the bone marrow are at restoring functioning ovaries and fertility to women with premature menopause / POI, but the results so far are encouraging. 

 

Egg freezing- the controversy continues

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Egg freezing- Is it effective and is it a "fertility insurance?"

Several years back the American Society for Reproductive Medicine declared that the freezing and storage of unfertilized eggs (oocyte cryopreservation) was no longer experimental. Reproductive science specialists have worked out the kinks and figured how to freeze, thaw, fertilize and grow these eggs, and from them get healthy live born children. The initial focus was to help women who wanted to have children, but were facing cancer treatment (surgery, chemotherapy or radiation) that might render them sterile. The data on pregnancy rates was very sparse but it in comparison to the alternative in these women, moving forward was a no brainer.

Now researchers in in Canada, have published on the outcomes in couples based on US data. The pregnancy rates range from 4-12 %, and that is in young women under 30.  The rates are likely much lower in women in their 30s and 40s. While not great, it does offer some hope where there was none before. The problems is that now egg freezing is being used to delay childbearing in women for social reasons. With the announcement by google that they will pay for the procedure in their employees and the advent of "egg freezing parties," this is becoming more widespread.

As reproductive medicine specialists, we all want to offer our patients reproductive freedom, the ability to have children at a time that works out in their lives. Undoubtably, freezing and storing eggs for future use will enable some women to have children well into their 40's and early 50's. However, those who are unsuccessful with frozen eggs, and there will be many of them, will be left little choice other than using eggs from a donor, knowing that their biologic clock ran out while they had other priorities in life.

The problem is this: Is egg freezing an answer to a real problem? or is it giving women false hope? It may be a little of both. Only time will tell as the technology moves forward.