Dr David Knight recently attended the Ovarian Club Conference where the program concentrated on many different aspects of Ovarian related infertility.
There were a number of fantastic innovations that Dr Knight has brought back to Australia including ideas that might help women who have been diagnosed with primary ovarian insufficiency (POI).
One of the aspects of the program Dr Knight was especially interested in was about potential ovarian rejuvenation treatments. He had the opportunity to discuss his approach with some of the world leaders in this field including Professor Kawamura in Japan; Professor Helen Picton and Professor Evelyn Telfer and Dr Norbert Gleicher of the Center for Human Reproduction. There were a number of cutting edge techniques discussed among the pioneering group including growing human follicles from scratch in the lab as well ovarian rejuvenation trials.
Prof Kawamura talked about the approach used for IVA (in-vitro activation), requiring two laparoscopic procedures to remove and replace ovarian tissue after exposure to gene activators and suppressors. This technique has seen recent pregnancies for women that had gone through early menopause. Dr Knight also talked with the professor about the prospect of drug-free IVA, a technique able to be performed as a day patient, involving laparoscopy and taking only 60-90 minutes of operating.
Discussions with Prof Milton Leong of Hong Kong revolved around data presented from his practice in regard to low dose FSH stimulation and individualising the start of an IVF treatment depending upon the time-specific ovarian status of the patient. Independently, Prof Leong also developed an approach very similar to the Demeter Fertility Over 40s Program to treating women in that reproductive age group. They shared ideas and both took some satisfaction that other world experts had similar views. Dr Gleicher talked about the role of DEAS in women with low AMH and POI, and the approaches and outcomes he presented were consistent with the Over 40s Program. He also talked about a recent ongoing pregnancy in one of his patients at the age of 48, using her own eggs!
Dr Gleicher and Dr Knight discussed their surgical techniques in relation to Inovium. Dr Knight expressed some scepticism in regard to the technicality of Dr Gleicher’s approach and the ability to perform such a precise technique in the circumstances. They both agreed that it was difficult, and that this difficulty may account for some of the variation in responses. Prof Picton theorised that the Inovium approach response may or may not be due to a specific factor but may be multifactorial, regardless the suppositions are biologically plausible, and no-one really understands the mechanism for the responses that are being observed.
So, a very interesting time. Current status, Dr Knight is leaning more to the reason for responses being activation of primordial oocytes rather than perhaps stem cells, but with the different approaches of Inovium, ASCOT, OFFA and IVA, there may well be different activators. Brave new world indeed!