Konstantinos Sfakianoudis, a gynaecologist at the Greek fertility clinic Genesis Athens, has reportedly restored pre-menopausal performance to post-menopausal ovaries using platelet-rich plasma. This piece explains the science and provides food for thought on the controversies surrounding this research.
According to the UK Office for National Statistics, there are currently more middle-aged women having babies than women aged under 25, which has long been considered to be the most biologically favourable time for women to get pregnant. As soon as the ovaries stop releasing eggs (normally around the age of 50 years old), women can no longer get pregnant. For approximately 1% of women who start menopause before the age of 40, the emotional trauma can be devastating.
Worrying about menopause may soon be consigned to history after it was reported in New Scientist earlier this year that a team headed by Konstantinos Sfakianoudis, a gynaecologist at the Greek fertility clinic Genesis Athens, could restore pre-menopausal performance to post-menopausal ovaries.
Sfakianoudis’s team’s reversed menopause by harnessing the regenerative wound healing properties of platelet-rich plasma (PRP). PRP is obtained from the patient’s own blood. By using high speed centrifugation, the researchers derived a substance which is rich in growth factors and other molecules that help wounds to heal. For example, platelet-derived growth factor and epidermal growth factor, which are key growth factors involved in the migration of fibroblasts towards the injury. These specialised cells secrete components of extracellular matrix- a substance with scaffold-like properties that provides structural support to cells within tissue.
PRP has been studied since the 70s but research into its potential therapeutic attributes only started gathering pace in the late 1990s. Since then, PRP gel has been used to treat a range of wounds that fail to heal unaided such as surgical wounds or chronic ulcers. However, the treatment is not without controversy and the effectiveness of the treatment is variable depending on which studies you read. The approach has not been standardly adopted by clinicians.
When Sfakianoudis’s team injected PRP into the ovaries of about 30 menopausal women between the ages of 46 and 49, the women’s menstrual cycles restarted. It isn’t quite clear why this would happen. One theory is that growth hormones in PRP facilitate the regeneration of tissue and production of ovulation hormones by ovarian stem cells. The treatment is believed to facilitate the release of eggs that weren’t released before menopause rather than increase the production of eggs, since it is still generally accepted that women are born with all their eggs. However, a recent article published in The Guardian suggests that women’s ovaries can actually grow more eggs. The article describes a study, which initially set out to determine why women receiving the chemotherapy agent ABVD did not suffer the same fertility issues as women on other forms of chemotherapy. Surprisingly, biopsies taken from the women on ABVD treatment had a higher density of eggs than healthy women of the same age. The findings are currently undergoing peer review prior to formal publication.
The eggs released from the ovaries of Sfakianoudis’s patients were isolated and fertilised artificially before being implanted in the uterus. Unfortunately, there are no reports of successful pregnancies from this technique and Sfakianoudis’s results have not yet been formally published in a peer-reviewed research journal. This raises important questions. For example, could you get the same results if you injected saline into the ovaries instead of PRP? It is also not known whether the resultant eggs are prone to being affected by genetic defects or how these defects might manifest in developing embryos. Given that successful pregnancies have not been reported, is it possible for a postmenopausal uterus to accept a fertilised egg? Although PRP is relatively safe in the hands of experts, the safety profile of its use in this context is also uncertain.
The majority of the women who might benefit from this treatment will be in their 40s and 50s. These mothers-to-be are more likely to suffer from potentially dangerous disorders such as pre-eclampsia and gestational diabetes than their younger counterparts; their eggs are more likely to be affected by chromosomal abnormalities, which increases the risk of miscarriage.
Robust evidence of effectiveness would certainly be needed before this approach is adopted in a fertility clinic near you. The New Scientist article mentioned several eminent UK-based scientists that urged caution over Sfakianoudis’s findings until they are verified and its likely that most other Western countries will share these sentiments. Furthermore, as seen with the explosion of international bogus stem cell clinics offering unproven stem cell therapies for every known illness or disability, there is a legitimate concern that Sfakianoudis’s technique might also be used to financially exploit vulnerable women.
Sfakianoudis’s treatment is a potentially ground breaking advance in fertility treatment for women. However, if this treatment does clear the necessary hurdles it must do so in order to become a standardised treatment, there needs to be a consensus on where to draw the line when it comes to who should be eligible. Age restrictions on the mother-to-be are too simplistic. Nevertheless, it is important that regulating bodies approving this treatment, clinicians administering the treatment and patients receiving the treatment carefully consider the long-term quality of life for the child that might be born.