Woman gives birth despite early menopause thanks to pioneering surgery

Pioneering day-surgery carried out by Barcelona's Hospital Clínic has so far enabled six post-menopausal women to become pregnant by stimulating egg production even after fertility has biologically ceased.

Clinical trials were carried out on 12 women who had all suffered a premature menopause – defined as under 40 years of age and affecting about 1% of Spain's population, or around 170,000 women.

Without using follicle-stimulant drugs, exactly half of them began to ovulate again following treatment, one of whom became pregnant and has just given birth.

María José Ortega was just 30 when she started the menopause – having tried to become pregnant and failed – and underwent five different types of IVF over the next two years, without success.

She was told that she had 'practically no eggs'.

As a last resort, she was referred to the hospital via the State health system for tests to see whether she would benefit from donor eggs, but gynaecologists suggested their new technique to her, which would – if successful – allow her to have a baby from one of her own eggs.

“The service the doctor gave me was excellent, so I trusted him and decided I had nothing to lose,” María José says.

She had surgery in October 2017 and gave birth to Daniela in August, aged 33.

Dr Francesc Fàbregues and Dr Francesc Carmona, who led the research project and carried out the operations, said theirs could be 'the technique of the future' and would 'open up many possibilities', but that it would need to be investigated further.

It involves cutting a section of tissue from the cortex of one ovary, near where the eggs are produced, then reducing it to tiny fragments and reimplanting it near the other ovary, which is activated as a result.

María José had IVF, so as not to waste time and eggs, although the two doctors say she could have fallen pregnant without fertility treatment if she had chosen to.

They based their technique on the concept of activating ovarian tissue in women in Japan who had gone through an early menopause, but the original procedure in the Asian country was different: Japanese gynaecologists placed the piece of ovarian tissue in a chemical substance for 48 hours before reimplanting it.

In the Japanese clinical trial, 30% of women started to ovulate again, although Hospital Clínic has achieved a 50% success rate without using any chemicals or medication.

Fragmenting extracted tissue and reimplanting as a way of reactivating an organ has proven effective with the liver, which led the gynaecologists in Barcelona to try it with the ovaries.

Instead of using suture, the Hospital Clínic surgeons use an adhesive material to 'stick' the reimplanted tissue to the ovaries, in order to minimise the risk of fragments becoming lost.

The procedure involves a laparoscopy and is an outpatient operation – the women do not have to stay in hospital overnight.

And in addiction to restoring the reproductive function of the ovaries, the surgery also reactivates the hormones produced by these glands.

But it is not yet clear for how long the ovaries will continue to produce hormones, which is why María José opted to go for IVF to speed up the process.

In some cases, however, women taking part in the trial were thought to have been among the non-success statistics but, six or seven months later, suddenly started to ovulate.

As yet, none of them have become pregnant, but both doctors are confident some of them will in the near future.

No plans have been considered yet to try the technique with women who have gone through the menopause at a 'normal' age.

In the event of a premature menopause, egg follicles remain in the ovaries, albeit very few – an enigma the medical profession has been unable to solve.