- Encouraging results are achieved in women under 40 years of age with the worst reproductive scenario at the ovarian level, thanks to the ASCOT technique – infusion of stem cells in the ovarian artery -, which was already successful in low responders
- The latest advance shows the benefits of mobilizing stem cells in the bone marrow and that, without injecting them, they reach the ovary themselves through circulation. This process is less invasive and easier to apply.
- Another finding shows the development in the follicles promoted by this technique, which has meant that some women regain menstruation and, therefore, reduce the symptoms of menopause
About 1 in 100 women under 40 have premature ovarian failure. This means that the ovaries, prematurely, stop their activity, which is one of the worst situations in the field of reproduction, since there are women who suffer from this pathology who do not even menstruate.
The doctors Sonia Herraiz, researcher at IVI Foundation-IIS la Fe, and Nuria Pellicer, gynecologist at Hospital la Fe in Valencia, have led a study that brings a halo of light to all these women who suffer premature ovarian failure.
As Dr. Pellicer explains: “the process consists, instead of managing the mother cells, something that has been done in the previous phases of this research, in letting them reach the ovary so that they can exert positive effects there. In both cases, both by administering the cells and only by mobilizing them, the stem cell releases growth factors that stimulate the cells of the tissue where it is to grow, proliferate or regenerate. In the case of the mobilization-only study arm, it is a less invasive procedure because cells are not administered, but they are allowed to reach the damaged ovary ”.
In the framework of the 36th Congress of the European Society for Human Reproduction and Embryology (ESHRE) this work has been presented, in which the study population has been expanded and is no longer limited to low responders, which provides a possibility for women under 40 years of age who suffer premature ovarian failure and who until now could not gestate with their own eggs.
What is the ovarian rejuvenation technique?
The ovarian reserve It is made up of primordial follicles that create the ovarian reserve. Each month around 1,000 follicles are activated, passing through all phases of development until they reach the mature ovum stage, a process that takes months. Also, many degenerate during the development process, leaving only one or two.
As Dr. Herraiz comments, “what this technique consists of is allowing these follicles, which, as the ovary is damaged, are not even activated, or if they are activated, they end up degenerating in the first steps of growth, to reach the stage of mature ovum, since we regenerate the environment or microenvironment in which they will grow and develop. All this process takes place inside the ovary ”.
Previous studies were limited to the introduction of stem cells into the ovary, but recent preliminary results indicate that the introduction of stem cells into the ovary may not be necessary, but that the cells and the factors they have secreted may reach through the circulatory system, in a much less invasive and simple process, so it could be applied in any clinic.
“With this we seek to develop a less invasive technique possible and standardize it to be able to implement it in all our clinics and offer any woman who wishes to be a mother the possibility of achieving it, even when her reproductive circumstances are unfavorable or clinically unviable without the intervention of science, such as that’s the case, ”adds Dr. Pellicer.
- One limited to the ASCOT technique, which is the infusion of stem cells into the ovarian artery, defined by the mobilization of cells, their extraction and their subsequent introduction directly into the ovary.
- And another, less invasive, which consists of mobilizing the cells, but allowing them to reach the ovary from the bloodstream, to see if they have the same effects as when you collect and inject them.
“This is where the second important advance of our work lies, and it is that we have verified that the mobilization technique is capable of making those ovaries work again and have follicles, so we have been able to demonstrate that both arms are able to promote the development of the follicles, and even some patients have recovered their menstruation, thus reducing the menopausal symptoms. However, we must be cautious, as these are the preliminary results of a study that is still under development. At the moment, embryos have been obtained in 2 of the 10 patients included and a 37-week pregnancy in the ASCOT arm, in patients with almost zero possibilities with the classic in vitro fertilization procedures ”, Dr. Pellicer tells us.
The ASCOT technique of ovarian rejuvenation, of which IVI is a world pioneer, consists of the transplantation of stem cells from the bone marrow into the ovarian artery (BMDSC, for its acronym in English: Bone Marrow-Derived Stem Cells). With this technique it is achieved that the ovary, as the organ responsible for ovulation, partially reverses its aging process and activates the dormant follicles, which otherwise would remain undeveloped. This technique has achieved an improvement in the biomarkers of ovarian function in 81% of the patients, becoming a reality for these women, both the low responders and those suffering from early ovarian failure. In addition, this technique has already achieved the birth of 3 babies and up to 6 pregnancies.
This technique had a first phase in an animal model that allowed to verify the effectiveness with stem cells. Then it had a second phase with low responding patients, a total of 20, whose stem cells were mobilized, extracted into peripheral blood and implanted again in the ovary, with the aim of coping with aging, activating the sleeping follicles. As a result, spontaneous pregnancies have occurred in women with low ovarian reserve after undergoing a bone marrow transplant. Given the success of the technique so far, a third phase was advanced, which consisted of analyzing women under 38 years of age with premature ovarian failure – a situation with a worse prognosis than in the case of low responders. In this phase of the study, the implementation aspect that we have already commented before was born.
Dr. Herraiz concludes: “a very encouraging line of research in which we will continue working with a single objective: to improve assisted reproduction techniques and treatments in order to obtain the best results in the largest population group, no matter how difficult it may be. look like the reproductive prognosis ”.
This process, which is popularly known as “ovarian rejuvenation“, Consists of the rescue of the dormant follicles of said ovary – not in their rejuvenation -, so this technique would be more convenient to call” ovarian rescue “. The stem cells activate this ovarian niche to rescue the follicles, so that they can grow and mature, in order to have mature eggs for the patients.
