MENOPAUSE need not be the end of fertility. A team claims to have found a way to rejuvenate post-menopausal ovaries, enabling them to release fertile eggs, 快猫短视频 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.
鈥淚t offers a window of hope that menopausal women will be able to get pregnant using their own genetic material,鈥� says Konstantinos Sfakianoudis, a gynaecologist at the Greek fertility clinic .
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鈥淚t is potentially quite exciting,鈥� says at Hull York Medical School in the UK. 鈥淏ut it also opens up ethical questions over what the upper age limit of mothers should be.鈥�
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 鈥� 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. 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 鈥�The pregnancy pause鈥�).
The menopause also comes early 鈥� before the age of 40 鈥� for around 1 per cent of women, either because of a medical condition or certain cancer treatments, for example.
鈥淚t offers hope that menopausal women will be able to get pregnant using their own genetic material鈥�
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鈥檚 blood to isolate growth factors 鈥� 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 . The treatment may work by .
Sfakianoudis鈥檚 team has found that PRP also seems to rejuvenate older ovaries, and presented some of their results at the 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.
鈥淚 had a patient whose menopause had established five years ago, at the age of 40,鈥� says Sfakianoudis. Six months after the team injected PRP into her ovaries, she experienced her first period since menopause.
Sfakianoudis鈥檚 team has since been able to collect three eggs from this woman. The researchers say they have successfully fertilised two using her husband鈥檚 sperm. These embryos are now on ice 鈥� the team is waiting until there are at least three before implanting some in her uterus.
The team isn鈥檛 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鈥檚 life, but we don鈥檛 know much about these yet. It鈥檚 possible that growth factors encourage such stem cells to regenerate tissue and produce ovulation hormones. 鈥淚t鈥檚 biologically plausible,鈥� says Sturmey.
Fertilised eggs
Sfakianoudis鈥檚 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.
鈥淚t seems to work in about two-thirds of cases,鈥� says Sfakianoudis. 鈥淲e see changes in biochemical patterns, a restoration of menses, and egg recruitment and fertilisation.鈥� 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 鈥� whether due to cysts, scarring from miscarriages or having a thin uterine lining. 鈥淭hey are the most difficult to treat,鈥� 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. 鈥淭hey are now in their second trimester,鈥� says Sfakianoudis.
Fertility aside, the technique could also be desirable for women who aren鈥檛 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鈥檚 team hasn鈥檛 yet published any of its findings. 鈥淲e need larger studies before we can know for sure how effective the treatment is,鈥� says Sfakianoudis.
鈥淥ne woman had been in menopause for 5 years. Six months after treatment, she had a period鈥�
Some have raised concerns about the safety and efficacy of the procedure, saying the team should have tested the approach in animals first. 鈥淭his experiment would not have been allowed to take place in the UK,鈥� says Sturmey. 鈥淭he researchers need to do some more work to make sure that the resulting eggs are OK,鈥� says at the .
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鈥檛 given PRP.
, an embryologist at Guy鈥檚 and St Thomas鈥� Hospital in London, is also sceptical. 鈥淚t is dangerous to get excited about something before you have sufficient evidence it works,鈥� 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 鈥� and whether there should be any. 鈥淚 lay awake last night turning this over in my mind,鈥� says Sturmey. 鈥淲here would the line be drawn?鈥�
Health issues like gestational diabetes, pre-eclampsia and miscarriage are all more common in older women. 鈥淚t would require a big debate,鈥� says Sturmey.
Sperm home test kit
How are the little swimmers doing? Low sperm counts or poor sperm quality are behind around a third of cases of couples who can鈥檛 conceive. A visit to a clinic for a test can be awkward, but a smartphone-based system lets men determine whether that鈥檚 necessary by checking their fertility at home.
Men often find it embarrassing to give a semen sample at a clinic, says Yoshitomo Kobori at the Dokkyo Medical University Koshigaya Hospital in Japan. So Kobori devised an alternative. 鈥淚 thought a smartphone microscope could be an easy way to look at problems with male fertility,鈥� he says.
Kobori and his colleagues came up with a lens less than a millimetre thick that can be slotted into a plastic 鈥渏acket鈥�. Clipped on to the camera of a smartphone, it magnifies an image by 555 times 鈥� perfect for looking at sperm.
To do a home test, a man would apply a small amount of semen to a plastic sheet around five minutes after ejaculation and press it against the microscope.
Watch them swim
The phone鈥檚 camera can then take a 3-second video clip of the sperm. When viewed enlarged on a computer screen, it is easy for someone to count the total number of sperm and the number that are moving 鈥� key indicators of fertility.
Kobori says the system works as well as the software used in fertility clinics. When the team ran 50 samples through both systems, they got almost identical results. The work was presented at the European Society of Human Reproduction and Embryology meeting in Helsinki this month.
The system can鈥檛 assess the ability of sperm to fertilise an egg. 鈥淭his method is only the simple version of semen analysis,鈥� says Kobori. But that could be enough for men to identify potential fertility problems, and decide whether to seek help from a doctor.
This article appeared in print under the headline 鈥淩eversing the menopause鈥�
