Have Scientists Finally Figured Out How to Turn Off Our Biological Clock?

If your first period signals the official “start” of your usefulness as a baby vessel, then menopause is the long, slow death wail of your fertility. No matter how much money you throw at your uterus, if your ovaries go menopausal it’s all systems no on mission pregnancy. Or, at least, it used to be. Everything might be about to change, thanks to new research that’s found that by harvesting your ovarian tissue before it goes kaput, freezing it, and then grafting it back onto your ovaries years later it’s possible to undo menopause and keep your fertility going for far longer than nature would have allowed. Obviously, that’s pretty cool, but it could also change life as we know it. Are visions of 80-year-olds clutching their newborn babies already crowding your head?

These futuristic sounding findings were delivered at a conference held by the European Society for Human Reproduction and Embryology in Istanbul this week. Doctors made the case that this ovarian tissue transplant should be moved from being an experimental treatment to being a mainstream option for all kinds of patients. Thus far, 28 babies have been born to mothers who received transplanted ovarian tissue and would otherwise have been infertile. Most of the pregnancies occurred naturally, with no IVF involved. While other researchers have been working on hatching eggs from ovarian stem cells in the lab, this kind of direct tissue transplant is a simpler alternative that has the power to extend a woman’s own fertile period.

This transplant technique was first reported on eight years ago, yet it has remained experimental and has only been done by a few specialists. But evidence is growing that this is a practice worth expanding. One piece of proof was presented at the conference by Dr. Gianluca Gennarelli from Clinica Universitaria Sant’Anna in Turin, Italy. The case involved a 21-year-old woman who in 2003 was diagnosed with cancer and was set to receive fertility-destroying chemotherapy. Some of her ovarian tissue was collected using laparoscopic surgery. It was then frozen and stored in liquid nitrogen. She underwent the chemo and, as predicted, became infertile. In 2010, she was ready to have children, and so they sewed 32 fragments of her thawed tissue back onto her ovaries. After two months, some of her ovarian function returned. Then she began having menstrual cycles and ovulating. Fifteen months after the transplant, she became pregnant without any additional medical intervention. She gave birth to a healthy baby in March of 2012. That is pretty amazing.

According to Dr. Sherman Silber, a surgeon at St Luke’s Hospital in St Louis, Missouri, who has been involved in 11 of these transplants, this technique is “robust”—since in some cases transplants done eight years ago are still working—and should no longer be considered experimental. He says, “It’s really fantastic, we didn’t expect a little piece of ovarian tissue to last this long.” Fantastic and a little freaky, since this is kind of like a little tiny ovarian fountain of youth.

The most obvious use for this procedure is to allow women who are undergoing cancer treatments to be fertile again after they achieve remission—and, indeed, most of the transplants done so far have been on cancer patients. It’s particularly well suited to them since the harvesting can be done right away, and it doesn’t require prolonged hormonal treatments like existing egg harvesting procedures do. As far as what the promise of control over their fertility offers to cancer patients, the researchers gave this whackadoo explanation:

All modern women are concerned about what is commonly referred to as their “biological clock” as they worry about the chances of conceiving by the time they have established their career and/or their marriage and their financial stability.

Most of our cured cancer patients, who have young ovarian tissue frozen, feel almost grateful they had cancer, because otherwise they would share this same fear all modern, liberated women have about their “biological clock.”

Ha, wow. Let’s unpack that a little bit before our heads explode and render our ovaries useless. First of all, while it is no doubt nice to know that your fertility is not rapidly expiring while you fart around trying to figure out what you’re doing with your life, it seems HIGHLY unlikely that anyone is really like, I’m totally psyched I got this cancer, Doc. It’s really taken a load off of my lady mind. BUT that gross overstatement aside, the idea of an eternal biological clock is definitely intriguing to all of us “career women,” as the Telegraph calls us in their article about this research.

Obviously, not all modern women are concerned about their loudly ticking biological clocks, but a large percentage of us definitely are at some point—at least if New York Times trend pieces and romantic comedies are to be believed. So what if this treatment could be extended to everyone, as these doctors are arguing it should be? They say that if we had our ovarian tissue harvested while we were still in our fertile period and saved it for later, it would effectively be a way of putting menopause “on ice.” Basically, the only thing stopping women from giving birth in their older age would be their “physical ability to carry a pregnancy.” Dr. Silber lays out how this might work:

A woman born today has a 50 per cent chance of living to 100. That means they are going to be spending half of their lives post-menopause. But you could have grafts removed as a young woman and then have the first replaced as you approach menopausal age. You could then put a slice back every decade.

In theory, this is awesome; though anyone who’s ever watched TLC’s Pregnant at 70 will know there are limits to just how appealing this is. For one thing, even if your ovaries can go on living forever, it doesn’t mean the rest of you will. Having children when you’re truly old means a much higher chance you’ll die when your kid is still young, and there are also serious practical downsides like having less energy to chase them around, etc. But what about for people who aren’t elderly but aren’t in their mid-30s anymore either. This certainly does seem like an appealing option for that demographic, and in some ways this is a simpler solution than undergoing multiple rounds of IVF or other fertility treatments.

In the broader sense, this kind of option would also level the workplace playing field to a certain extent. If women were no longer running headlong into the concrete wall of menopause, it would free us up to make career decisions and child-bearing decisions based entirely on what we wanted to do, not on what nature might be planning for us. We could FINALLY “have it all.” (Gaaaahhh.) Granted, we’d have to pay for a likely expensive procedure to work around nature; whereas men don’t have to do anything to stay fertile. But at least this option would remove some of the time pressure we’re under at the moment.

Of course, as with anything that radically messes with one’s body, there are probably some major downsides. Really, we have no idea what the implications of this are and whether it would even be possible to put off menopause for an extended period as these researchers are suggesting. Dr. Tim Hillard, a British gynecologist and expert on menopause, calls this development “exciting,” but he says we have a long way to go:

[W]e would need much more data before claims could be made about the menopause. You would have to balance it very carefully, the higher risks of breast and womb cancer that go with having oestrogen circulating for longer against the increased risk of heart disease, oesteoporosis and maybe dementia that go with the menopause. Theoretically it could be used as an alternative to hormone replacement therapy, particularly in women who go through the menopause prematurely, but that could be ten or 15 years away.

Blerg. Okay, but seriously, health consequences aside, let us not forget a major downside which none of the doctors seem to consider: this means you’d have your period for almost your entire freaking life. As much as extended fertility would be a blessing, an eternal menstrual cycle sounds more like a wretched curse. Either way, it sounds like we’ll still have to wait a while before we have to commit to a few extra decades of visits from Aunt Flo—though if the tampon companies catch wind of this possibility, they’ll probably jump on board and fund this research so fast we’ll be able to start doing this next week. In the meantime, let’s hope cancer patients can benefit from being able to preserve their fertility, and the rest of us better start mentally preparing ourselves to be chasing our toddlers around at our retirement parties.

Fertility preservation with cryopreservation of ovarian tissue: from experimental to mainstream [EurekAlert]
Women could delay the menopause indefinitely with ovary transplant: doctors [Telegraph]