A New Approach to Infertility Management

By: Tiffany Parnell
Wednesday, April 16, 2014

For women with primary ovarian insufficiency (POI) who wish to have children, few options exist beyond adoption and egg donation. A new technique developed by researchers at Stanford University School of Medicine, however, may hold the key to unlocking POI-related infertility.

Building on previous research that suggested women with POI may have microscopic, dormant eggs within their ovaries, Aaron Hsueh, PhD, Professor of Obstetrics and Gynecology at Stanford, performed a study in mice with ovarian failure to see if it was possible to awaken dormant follicles within failing ovaries. His positive results have led to a breakthrough technique in the field of infertility management known as in vitro activation.

“Dr. Hsueh found that in mice with ovarian failure, removing the ovarian tissue, treating it in the laboratory with a combination of PTEN inhibitors and growth factors, and mincing the tissue awakened dormant follicles that had been completely resistant to other ovulation efforts,” says Valerie Baker, MD, Chief of the Division of Reproductive Endocrinology and Infertility and Medical Director of the Stanford Fertility and Reproductive Medicine Group at Stanford University. “This discovery was a real shock and has led to the first promising technique for women with extremely depleted egg supplies whose only other options would be egg donation or adoption.”

Following the successful results in mice, Dr. Hsueh and Yuan Cheng, PhD, began collaborating with researchers at St. Marianna University School of Medicine in Japan. The international team examined the in vitro activation technique in women suffering from severe POI. That research also yielded promising results.

To test the technique, Japanese researchers removed an entire ovary or a portion of an ovary from each participant. Replicating the procedure used in mice, PTEN inhibitors, growth factors and mincing techniques were employed in the laboratory to awaken any dormant follicles within the ovarian tissue. The tissue was then reimplanted near the fallopian tubes, and growth hormones were administered to stimulate egg development.

Of the 27 Japanese women who participated in the initial study, five developed mature eggs, which were harvested for in vitro fertilization. So far, one woman has given birth to a healthy baby boy, and another woman is pregnant.

Hope for the Future

Dr. Baker plans to begin offering this experimental technique at Stanford by mid-2014. Because initial research indicated women have the greatest chance of achieving pregnancy when POI is diagnosed early, she encourages physicians to check the egg supply in women who have irregular menstrual cycles at earlier ages.

“Though it will take years of performing this technique before we are able to determine who will be the best candidate for treatment, in our preliminary experience in Japan, it appears that this technique works best in women who are only two to three years past their last menstrual period,” Dr. Baker says. “While the standard of treatment for POI is still egg donation, for women who do not find egg donation acceptable, I think there’s hope that this experimental treatment will provide another choice.”