Experimental treatment offers hope of fertility for early menopausal women

Menopause typically signals the end of a woman's ability to become pregnant. However, in a small new study, a novel approach of administering platelet-rich plasma and gonadotropins near the ovarian follicles is showing promise in restoring ovarian function. Study results are published online today in Menopause, the journal of The North American Menopause Society (NAMS).

As more women look to build their careers before pursuing motherhood, the average age of conceiving a child continues to be pushed back. For some of these women, however, their hope of becoming pregnant is cut short by the onset of early menopause, which is described as the cessation of ovarian function at or before the age of 45 years. It is estimated that roughly 12.2% of women experience early menopause. For these women, the only chance of becoming pregnant is with donor eggs.

Multiple treatment options have previously been investigated, including standard, controlled ovarian stimulation. Platelet-rich plasma has been used in women with primary ovarian insufficiency, but few pregnancies and live births resulted. With the failure of these somewhat traditional treatments, more novel approaches, such as methods for inducing the growth of ovarian follicles, are being pursued.

In this new, small-scale pilot study, platelet-rich plasma and gonadotropins were injected into the ovaries of study participants, with some fairly amazing results. After treatment, 11 of the 12 study participants resumed menstruation, and one achieved clinical pregnancy, defined as a pregnancy that is confirmed by ultrasound as well as a fetal heartbeat.

Although more research and larger studies are needed, these early results regarding the successful resumption of ovarian function offer hope to women in early menopause who may be able to pursue pregnancy through in vitro fertilization using their own eggs.

Abstract

Objective:

This study was designed to investigate if whole dimension subcortical ovarian administration of platelet-rich plasma with gonadotropin, in proximity to most ovarian follicles, is effective in restoring ovarian functions in women during early menopause.

Methods:

Platelet-rich plasma, prepared from 40 mL of autologous peripheral blood using the buffy coat method, was injected into extended subcortical area of bilateral ovaries along with recombinant follicle-stimulating hormone (rFSH) (Gonal-F 300IU) under laparoscopic guidance. The posttreatment ovarian folliculogenesis and serum levels of FSH, luteinizing hormone (LH), and estradiol were followed up for 6 months at weekly to monthly intervals. IVF was carried out in women resuming ovulatory functions.

Results:

Twelve early menopausal women with mean age of 44.42 ± 2.84 were enrolled. After treatment, 11 women resumed their menstrual period in 37.1 ± 23.5 days. Their average serum FSH was 70.47 ± 20.92 and 26.22 ± 17.55 IU/L, luteinizing hormone was 34.81 ± 11.86 and 14.3 ± 12.8 IU/L, before and after treatment, respectively. The mid-cycle E2 was 251.1 ± 143.8 pg/mL. Ten oocyte retrievals were carried out among six participants, four of them received controlled ovarian stimulation and another two using natural ovulation cycles. Thirteen mature eggs were retrieved which were then ICSI fertilized to obtain 10 normally fertilized 2PN oocytes. Two participants had cleavage stage embryos transferred of which one achieved clinical pregnancy.

Conclusions:

Whole dimension subcortical ovarian administration of platelet-rich plasma with gonadotropin was shown to restore ovarian functions, at least temporarily, and could increase the probability of pregnancy using autologous oocytes in women with early menopause.

Reference

Chao Chin Hsu, Isabel Hsu, Leonard Hsu, Yi Jen Chiu, Sonam Dorjee. Resumed ovarian function and pregnancy in early menopausal women by whole dimension subcortical ovarian administration of platelet-rich plasma and gonadotropins. Menopause, 2021; Publish Ahead of Print DOI: 10.1097/GME.0000000000001746