Behind the headlines: Could a simple jab reverse infertility?

A new fertility treatment for women? Emma Baines reports

What is the story?
Infertile women have been offered ‘new hope’ by research showing that injections of a hormone could reverse infertility, according to media reports.

The papers said that the hormone kisspeptin, which has previously been identified as the genetic switch that ‘turns on’ puberty, also has the potential to become one of the treatments offered to the one in nine couples in the UK who are affected by infertility.

Scientists found that injecting kisspeptin into healthy women raised the levels of a hormone important for ovulation.

This means that kisspeptin injections could be used to help restore normal reproductive function in women who have no periods, those with irregular cycles or who have a period but do not ovulate, the papers said.

What is the research?
The media reports are based on a small study measuring the effects of kisspeptin on the hormones of healthy women, which was presented at the Society for Endocrinology Spring meeting in Birmingham on 6 March.

KiSS-1, the gene that encodes the hormone kisspeptin, was first shown to play a role in fertility in 2003 when researchers found that people and mice lacking this gene failed to go through puberty. Since then, many studies have been carried out in animals showing that kisspeptin plays a pivotal role in the control of reproduction.

The present study is the first to measure the impact of kisspeptin on hormone levels in women.

Researchers administered an injection of either 0.4nmol/kg kisspeptin or a placebo to six healthy women on six occasions, twice during the follicular, preovulatory and luteal phases of their menstrual cycle.

They found that the women’s levels of luteneising hormone (LH) were raised following kisspeptin administration during any phase of the cycle.

However, sensitivity to kisspeptin was highest in the preovulatory phase, producing a more than 20-fold increase in LH levels.

Sensitivity to kisspeptin was lowest during the follicular phase, producing an average increase in LH levels of just 12 per cent.

What the researchers say?
The researcher who presented the study at the conference, Dr Waljit Dhillo, from the Department of Metabolic Medicine at Imperial College London and the Hammersmith Hospital said: ‘This is the first study to administer kisspeptin to healthy women and we found it did what we expected kisspeptin to do, based on the animal studies. It stimulated reproductive hormone secretion.

‘The next step is obviously to look at its effects on women with abnormal periods to see if they can start having normal periods with kisspeptin treatment.’

He explained that kisspeptin appears to work by triggering the hypothalamus to release normal levels of reproductive hormones.

‘If there’s an abnormality, wherever that abnormality is, if you can kick-start the system back into a normal function then you may be able to restore fertility in women with abnormal menstrual cycles. That’s what we’re hoping to achieve.’

He said that there were many causes of infertility and stressed that a treatment based on kisspeptin could only help around a quarter of infertile couples.

‘About half of infertility is caused by female problems and of the female fertility problems, about half will be down to a failure to ovulate. It may be of use in those patients.’

He said that a therapy using kisspeptin would work in a similar way to existing fertility treatments in that for some women injections would be enough to restore normal fertility. For other women it would be used as part of an IVF programme.

‘We’ve shown that in the ovulatory phase, kisspeptin is very potent at triggering the release of LH and stimulating ovulation. So if that was the only problem you could use it as injections to stimulate ovulation.’

He said that if further trials were successful, a fertility treatment based on kisspeptin could become available within five or 10 years.

What do other experts say?
Sheena Young, Head of Business Development for Infertility Network UK said: ‘This is obviously very good news for women who suffer from ovulatory problems. 

‘However, this new development will require further research before becoming widely available to patients.’

Dr Allan Pacey, senior lecturer in Andrology at the University of Sheffield and secretary of the British Fertility Society said that even if kisspeptin was found to successfully trigger ovulation in infertile women, that would not radically change the way that infertile women are treated.

‘There are already a number of existing techniques for triggering ovulation,’ he said.

‘If all they are doing is triggering ovulation by another route then I can’t see that kisspeptin does much that existing therapies can’t do.’

He added that kisspeptin would have to be trialled alongside existing treatments for stimulating ovulation, including gonadotropin-releasing hormone (GnRH) and LH injections before it could be recommended as an alternative to existing fertility treatments.

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