The premature ovarian failure (POI) It is a harsh reality faced by approximately 1 in 100 women under 40 in our country. This premature cessation of ovarian activity deprives women of being able to become pregnant with their own eggs, so they would have to resort to egg donation in order to carry a baby.
“At the reproductive level, this premature cessation of activity of the ovaries is one of the worst scenarios we can find. This patient profile does not even menstruate. Aware of this, we have carried out extensive research work. Thus, we can offer these women the 4-step ASCOT technique. It is an ovarian activation process that could be a viable solution for many of them, giving them the possibility of gestating with their own eggs “, explain it Dr. Sonia Herraiz, researcher at the IVI Foundation-IIS La Fe. The doctor is also the author of the study “Stem cell secreted factor therapy regenerates the ovarian niche and rescues folicles”, Recently published in the prestigious scientific journal American Journal of Obstetrics and Gynecology.
IVI seeks 42 patients for a new trial
From IVI we are going to carry out a new trial, with 42 patients who want to participate voluntarily. We are looking for women under 39 years of age, with premature ovarian failure without apparent cause, who will later be able to choose motherhood with their own gametes. The research team will be in charge of assessing that each patient is suitable to participate in the study, based on established criteria. In addition, patients must have availability to travel to Valencia, since it will be in this IVI clinic where the first steps of the study will be carried out.
Once the 4-step ASCOT technique has been performed, the patients will continue with a follow-up for the following 6 months. Every two weeks an analysis and ultrasound should be performed. During this period, it will be checked, first, if the menstruation recovers. It will also be studied if the levels of FSH fall and if the antimüllerian hormone (AMH) rises. And, most importantly, it will be observed if antral follicles begin to appear.
“As soon as they appear, we will give the patients a stimulation. We will try to collect these follicles that, otherwise, could not be recovered. For these patients, this could be the only option of being mothers with their own oocytes “, explains Dr. Sonia Herraiz.
During the six months of development of the 4-step ASCOT technique, if follicles appear and after verifying the evolution of the patient, an in vitro fertilization treatment (IVF) will be carried out with the eggs themselves, as usual.
Women who meet the criteria and are interested can fill the form to sign up for the IVI trial to perform the 4-step ASCOT. Each case will be studied to see if they can participate in the study.
What is the 4-step ASCOT technique?
This technique has a previous work with stem cells that, in the case of the ovary, secrete growth factors that stimulate the cells of the ovary to grow and develop. To this must be added the PRP (platelet-rich plasma). It consists of concentrating the platelets, since they have different growth factors. Thus, the 4-step ASCOT technique unites the two technologies, in a process divided into 4 steps:
- Stem cell mobilization for 5 days, using a standard procedure – similar to bone marrow or stem cell donations. This is done by daily subcutaneous injections of GCSF (Granulocyte colony-stimulating factor). The objective of this first step is to enrich the blood in stem cells and in the factors that they secrete, that is, positive growth factors.
- PRP preparation. In this second step it is necessary for the patient to go to the clinic to have a blood drawn. This blood is centrifuged to prepare the PRP that, previously, is enriched in factors secreted by stem cells.
- Activation of PRP, by breaking platelets, so that the factors come out.
- Direct injection into the ovary of PRP, in an intervention similar to ovarian puncture. This last step consists of injecting the concentrate rich in growth factors at different points of the ovary.
“This procedure is based on the combination of two techniques that have already shown positive effects on the ovary. Furthermore, it is always autologous –with the patient’s own blood–, thus avoiding all possible compatibility problems that may arise. There is an internal part, which is the mobilization of stem cells, which happens within the patient herself. And an external part, which is the extraction of previously enriched blood, its centrifugation and activation in PRP, to release the additional growth factors that platelets contain. The last step is injecting the PRP into the patient’s ovaries ”, explains Dr. Herraiz.
After carrying out this process, the patient could start an in vitro fertilization treatment (IVF) to be able to become a mother with her own eggs.
The blood signature and how to defy old age
The composition of the plasma of the patients is different before initiating mobilization and after it, since it has been previously described that there is a blood signature.
“When you are young, your blood is rich in growth factors and positive things, but as you age, the concentration of these growth factors decreases and all the inflammatory molecules and those associated with certain diseases begin to increase, which is why we become old. The intention of the present study is to reactivate ovarian function through the injection of growth factors in patients who are suffering ovarian failure earlier than expected according to their biological age ”, adds Dr. Sonia Herraiz.
Stem cells: bone marrow vs umbilical cord
The study previously referenced –Stem cell secreted factor therapy regenerates the ovarian niche and rescues folicles– compared the results on the ovary of the secreted factors, both from bone marrow stem cells and from the umbilical cord. After an in-depth study, it was confirmed that the results are better, in some points, with bone marrow stem cells.
“This, at a clinical level, has the advantage that, in the end, we will always work with autologous blood. We do not have the need to go to a cord blood bank, HR tests, etc., which greatly facilitates the process “, concludes Dr. Herraiz.
