GUADALAJARA, MEX. “Previously, gynecologists were familiar with the topic of premature menopause, which has now been labeled as primary or premature ovarian failure,” an entity that affects very young women in whom their ovarian reserve is depleted.[1]
This is what he said to Medscape in Spanish Dr. Luis Ruvalcaba Castellón, founding member of the International Society of Uterus Transplantation (ISUTX) and professor at the University of Guadalajara in the subspecialty of Reproductive Biology at the Mexican Institute of Infertility (IMI), who gave the conference Premature ovarian failure, during the XXXI International Congress of Gynecology and Obstetrics.
Dr. Luis Ruvalcaba Castellon
“When a woman is gestating in her mother’s womb, she has the most follicles at 20 weeks, approximately 20 million, and is born with two million; when menarche arrives, which is the first menstruation, she has approximately 200 to 400,000 follicles, of which many go to atresia, obviously not all of them are for ovulation,” said Dr. Ruvalcaba.
The specialist recalled that there are conditions, such as Turner syndrome, in which women have a genetic problem that causes the ovaries to lose eggs rapidly, “not necessarily because they ovulate, but because they deteriorate, which we call apoptosis.”
“As gynecologists, our goal is to identify the antral follicle count and status in a timely manner using ultrasound with the support of the anti-Müllerian hormone test, which is not new, it dates back 10 or 15 years and has given us the most important tool to see its real reserve,” she added.
This can help doctors encourage women who are not planning a pregnancy in the near future to freeze their eggs before they do not have them when they decide to become mothers.
According to the expert, this problem occurs frequently. “There is an epigenetic factor, the environment, which is not the same today as it was years ago: more pollution, stress, habitat changes, abuse of toxins, COVID-19 itself and all these external situations greatly affect the ovarian reserve.”
Early detection of premature ovarian failure in women under 38 years of age can be decisive, “because if their life plan includes becoming mothers, they must freeze eggs so that in the future they will have the same eggs of the same chronological age at the time of freezing and not wait for a future time when they no longer exist.”
In the case of patients who already have premature ovarian failure, the treatment consists of activating the dormant follicles “with the technique in vitro activation “We learned this in Japan from Dr. Kazuhiro Kawamura; at the Mexican Institute of Infertility we have already applied it to five patients, one of whom became pregnant,” said Dr. Ruvalcaba.[2]
The option of egg vitrification
“From Japan we brought to a large part of Latin America the best freezing in the world, called vitrification; we have the experience since 2004 of detecting women who are moving towards primary ovarian failure or premature ovarian insufficiency in a timely manner,” the specialist emphasized.
In women who undergo chemotherapy or radiotherapy, the ovaries are affected and do not produce gametes, she added.
“Before patients undergo chemotherapy or radiotherapy, we freeze their eggs, and in those with ovarian problems, we perform gynecological freezing, because if we are going to remove benign tumors, their reserve inevitably decreases,” he said.
Dr. Ruvalcaba mentioned that the most difficult cell to freeze is the egg. “In order to defrost an egg in the previous phase, called the slow phase, only one of 200 eggs that were frozen survived. Now, with vitrification, all the eggs can be recovered.”
According to the specialist, these cells freeze at minus 23,000 degrees Celsius per minute and thaw at plus 42,000 degrees Celsius per minute. “How is it measured? There are electronic thermometers in Japan that measure these speeds; with freezing and heating speeds you don’t give the cell time to suffer any cryoinjury.”
“Vitrification is for the benefit of our patients. It is a safe, simple, easy technique with a 100% recovery rate,” emphasized Dr. Ruvalcaba, adding that since 2008 they have published the work of the first 200 live births in the world with this technique.[3]
“This type of information is intended to inform women in general that they need to undergo gynecological check-ups to check their follicles, anti-Müllerian hormone and see if they are in optimal time to postpone a pregnancy, and if there is any risk that their reserves are running out, it is necessary to freeze their eggs,” she concluded.
Dr. Ruvalcaba Castellón declared that he has no relevant financial conflicts of interest.
