By Jody Lin, M.D.
In research that might redefine the limits of reproductive technology, scientists were able to restore fertility to five completely infertile women, one of whom later delivered a baby.
The unlikely new mother was a 29-year-old Japanese woman who had been in early menopause. She delivered a healthy baby boy in December using a new procedure developed at Stanford University. The study and the birth were reported Monday in the Proceedings of the National Academy of Sciences.
The experiment was a small one; it involved 27 women in Japan with a condition called primary ovarian insufficiency, in which patients enter early menopause before the age of 40. Of these women, the researchers were able to help eight of them ovulate. They were able to create embryos from eggs retrieved from five of the women. Thus far, two of the women have become pregnant, and one has already successfully given birth, and the other is still pregnant.
While the procedure is still in its infancy, the authors of the report say it could have widespread applications to women who are barren and those who have low rates of ovulation.
"This procedure could be helpful to cancer survivors … [and] middle-aged woman with infrequent menses," said lead study author Dr. Aaron Hsueh, who is a professor of obstetrics and gynecology at Stanford University.
The procedure is experimental for right now, and likely far too invasive to be considered by most women. It involves removing a woman's ovary, cutting it into small pieces, treating these pieces with a medicine that stimulates egg development and re-implanting pieces of that ovary near the fallopian tubes, according to the study.
But while the procedure in the study might seem very invasive, Hseuh said he hopes to develop a more local, less invasive treatment in which the medicines used in the study can be directly injected into patients, thus bypassing the surgical removal of the ovary that was done in this study.
Hsueh added that one day, when it is combined with today's IVF technologies, it might help increase the overall rates of successful pregnancies.
Dr. Rick Paulson, director of the fertility program at the University of Southern California, said the study, while preliminary, might offer promise going forward for women who today have no real prospects of being able to get pregnant.
"This is completely outside of current clinical practice," said Paulson, who was not involved with the study.
It is especially interesting that the researchers discovered a treatment "within the ovary that's non-hormonal, that's non-endocrine based," because this could potentially allow women to avoid systemic hormone treatments that have certain side effects, he added.
But other fertility experts were quick to point out that more understanding is needed before this treatment makes it into the fertility clinic.
"The most fascinating part of this is I don't think they understand the mechanism of why the technique worked," said Dr. Sherman Silber, director of the Infertility Center of St. Louis.
But the work does show how modifying the tissue of the ovaries can lead to the production of viable eggs, an important step in any assisted pregnancy, he added.
With a growing number of U.S. women delaying childbirth, infertility has become an increasingly relevant medical issue. This study shows that promising new treatments for infertility might be around the corner, particularly for women at the worst end of the spectrum when it comes to infertility.
There are, however, far more women who struggle with infertility because of factors related to their age. For such women, this approach to treatment will not be the best way to go, at least not yet.
The take-home message for now is that women who delay childbirth should learn about the "insurance policies" that today's technology offers: freezing eggs for later use, for example, just in case natural pregnancy turns out to be difficult later.
In the future, however, studies like this one might make treatments such as IVF more tolerable for women hoping to add a child to their lives.