transplant

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. 

 

Live birth after uterine transplant

Live birth after uterine transplant: Princeton IVF blog

Doctors at Baylor University deliver the first US baby born following uterine transplantation

A few years back, doctors in Sweden performed the first successful uterine transplant. Several academic fertility centers in the US have tried to replicate this here, and doctors at Baylor announced they were the first to do so.

Why would one want to transplant a uterus?

It is impossible to carry a baby without a uterus, also known as the womb. The early embryo implants itself into the wall the uterus about a week after conception and through the placenta and umbilical cord, its interface to the uterus, the fetus gets all of the nutrients and oxygen it needs to grow and even to survive.

Some women are born without a uterus (such as in the Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome), some have scar tissue in the uterus and others have had their uterus removed (a hysterectomy) for fibroids, cancer or some other reason. While there have been many many cases of ectopic pregnancies, where a pregnancy implants outside the uterus, these pregnancies nearly always need to be terminated early on since they can result on the death of the mother, and almost never results in a live birth of a baby. There is also interest in using a transplanted uterus in transgender women.

Are there alternatives ways to have baby without a uterus?

Currently, there is a very effective way of having a baby without a womb, and it is called Gestational Carrier IVF.  The eggs are harvested from the intended mother, sperm is collected from the intended father, and fertilization is performed in the IVF laboratory. The embryos are grown and transfered into the uterus another woman, referred to as a gestational carrier after her uterus is prepared for pregnancy using hormonal treatments. This can be costly (but much less so than a uterine transplatation), is illegal in some states and most importantly, the pregnancy is carried and delivered by someone else other than the intended mother.

How is a uterine transplant performed?

The uteri used for transplantation can be obtained from living donors or women who have recently passed away and offered their organs up for donation. Using an open incision (laparotomy in medical jingo), the donor uterus is attached the various blood vessels to ensure it has good supply and to attached to nearby structures to hold it in place. It is not attached to the fallopian tube.

How does a woman get pregnant after uterine transplantation?

IVF (in vitro fertilization) is required to achieve pregnancy since without a connection between the tube and uterus, pregnancy would otherwise be impossible. In years past, fertility surgeons, connected fallopian tubes to the uterus, but that operation has been abandoned since it rarely worked. IVF bypasses that problem and offers the best chance for pregnancy.

Are more uterine transplant babies coming?

The doctors at Baylor have another woman pregnant after uterine transplantation and IVF, a few more attempts planned. A number of women undergoing the procedure have not been successful. Other centers are trying this as well, but the costs are so high and it is not covered by insurance, so it not clear how widespread this will become.