It appears as if menopause may not be the end of fertility as a team claims to have found a way to rejuvenate post-menopausal ovaries to enable the release of fertile eggs. The technique is suggested to have been able to restart menstruation in menopausal women, including one who had not menstruated in 5 years. If the results are able to withstand further scrutiny the technique may boost fertility in older women and allow those experiencing early menopause to become pregnant, as well as help to stave off the detrimental effects of menopause.
Professor Konstantinos Pantos is the fertility specialist who led the study in Greece, and he has been offering PRP treatments privately for the past 5 years, “we have treated several hundred women’ who were looking either to conceive or reduce the symptoms of menopause.” According to Pantos “They have a right to have a child, and we have to help them.”
“It offers a window of hope that menopausal women will be able to get pregnant using their own genetic material,” says Konstantinos Sfakianoudis, a gynecologist at the Greek fertility clinic Genesis Athens.
“It is potentially quite exciting,” says Roger Sturmey at Hull York Medical School in the UK. “But it also opens up ethical questions over what the upper age limit of mothers should be.”
Women are thought to be born with all of their eggs, the number steadily declines between puberty and menopause with a fertility peak in the 20s. But around the age of 50, the ovaries stop releasing eggs, but most women are already largely infertile by this point as ovulation becomes more infrequent.
More women are having children in their 40s than ever before, but as more choose to delay motherhood many may find themselves struggling to become pregnant. Those who are hoping to conceive later in life are increasingly looking towards IVF and egg freezing, but neither are a for sure or truly reliable backup option.
For many women, life gets in the way of the best-laid plans and menopause can come all too early, even before the age of 40 for 1% of women either due to a medical condition or certain cancer treatments as examples. The researchers suggest that when PRP was injected into the ovaries of menopausal women, it restarted their menstrual cycles and enabled them to collect and fertilize the eggs that were released.
Sfakianoudis and colleagues are turning to a blood treatment that is used to help heal wounds faster to help turn back the fertility clock for women who have experienced early menopause. PRP is made by centrifuging a sample of a person’s blood to isolate growth factors, and it is widely used to speed the repair of damaged bones and muscles. The team has found that PRP also seems to help rejuvenate older ovaries, and they have presented some of their research at the annual meeting of the European Society of Human Reproduction and Embryology.
“I had a patient whose menopause had established five years ago, at the age of 40,” says Sfakianoudis. Six months after the team injected PRP into her ovaries, she experienced her first period since menopause. Since then 3 eggs were collected from this woman, 2 of which were successfully fertilized using her husband’s sperm, the embryos are now on ice waiting to be implanted into her uterus.
The team suggests that they have given PRP in this way to 30 women between the ages of 46 and 49 who all want to be able to have children, and they say that they have managed to isolate and fertilize eggs from most of them.
“It seems to work in about two-thirds of cases,” says Sfakianoudis. “We see changes in biochemical patterns, a restoration of menses, and egg recruitment and fertilisation.” His team has yet to implant any embryos in post-menopausal women, but hopes to do so in the coming months.
In another group of women, this approach has already been helpful for pregnancy says Sfakianoudis. 10% of the women seeking fertility treatment at the clinic have a uterus that embryos have difficulty attaching to. After injecting PRP into the uteruses of 6 women who previously have multiple miscarriages and failed IVF attempts, three went on to become pregnant through IVF and are in their second trimesters.
Besides helping with fertility this treatment may also be desirable for those wanting to ward off hormonal changes that can also make the heart, skin, and bones more vulnerable to ageing and disease. Many women may be somewhat reluctant to take hormone replacement therapy to reduce these changes due to the link with breast cancer, but rejuvenating the ovaries with PRP could provide an alternative way to boost the supply of hormones that could delay the symptoms of menopause.
Sfakianoudis and the team have not published their findings yet saying that “We need larger studies before we can know for sure how effective the treatment is.” The researchers will also need to carry out randomized trials with a control group to know if their treatment really does improve fertility.
Although promising for many, this work does raise concerns over the safety and efficacy of the procedure which was not tested on animals first. It also raises ethical questions over upping the age limits of pregnancy and health issues like gestational diabetes, pre-eclampsia, birth defects, and miscarriage which are all more common in older women.
“Obviously it’s a very interesting topic [that] could be beneficial to a lot of people,” said Heather Shapiro, president of the Canadian Fertility and Andrology Society, adding that ovaries have many other functions beyond eggs. “The big one is making estrogen,” which may help ward off conditions such as heart disease. A decline in estrogen has been linked to an increase in heart disease in post-menopausal women. But she cautions against getting excited about these findings because more work is needed, and she believes we are still years away from safely being able to use this kind of procedure on humans.
“This experiment would not have been allowed to take place in the UK,” says Sturmey. “The researchers need to do some more work to make sure that the resulting eggs are OK,” says Adam Balen at the British Fertility Society. “I lay awake last night turning this over in my mind,” says Sturmey. “Where would the line be drawn? It would require a big debate,” says Sturmey.
Virginia Bolton, an embryologist at Guy’s and St Thomas’ Hospital in London, is also skeptical. “It is dangerous to get excited about something before you have sufficient evidence it works,” 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.
Sfakianoudis and colleagues are also testing the PRP technique on women’s uterine linings as well as on men’s testes to help counteract male factor infertility.
Professor Konstantinos Pantos is overseeing 4 randomized, placebo-controlled clinical trials, with another 2 trials being run by Professor Emre Seli at Yale School of Medicine to confirm PRP as a viable infertility treatment.
“I can’t tell you 100 percent that this is going to be a super useful intervention,” said Professor Seli. “But I find it very exciting.”
