Hope for Women Facing Infertility Treatment
By Vanessa Curto
Cindy sought out doctor after doctor in her quest to have a child. She was diagnosed with autoimmune ovarian failure, a mysterious disorder in which the immune system is believed to attack the ovaries. In 1991, she began taking dexamethasone, a powerful drug that suppresses activity of the immune system. Nine months later, she still wasn't pregnant. But she began to have pain in her knee. Eventually, doctors found the treatment had cut off blood flow to her bone and caused her right knee to decompose. After undergoing experimental surgery, she can walk, but can no longer run, or play tennis or any other high-impact sports. Eventually, she will need to have the knee replaced entirely.
Several years later, Cindy was reading through a physician's newsletter when she came across an article about Dr. Lawrence Nelson's research. Nelson is an NICHD investigator who studies ovarian failure. He hopes to provide a lower risk alternative to the high-dose immune suppressive treatment that Cindy received.
When Cindy contacted him, Nelson explained to her that autoimmune ovarian failure is a little-studied phenomenon. For reasons no one completely understands, the ovaries of some women stop functioning prematurely, sometimes as early as their teens or twenties. As a result, ovulation ceases, menstruation stops, and blood levels of the female hormone estrogen fall off dramatically. In some cases, the women have antibodies that bind to tissue in the ovaries; in these women the disorder is believed to result from an immune attack on the ovaries.
Because of the presence of antibodies against ovarian tissue, physicians have believed that prescribing drugs such as dexamethasone or prednisone to suppress the body's immune system will allow women's ovaries to develop and release eggs for fertilization. Nelson points out that physicians have relied largely upon anecdotal evidence of these drugs' success and safety.
"The present treatment has a lot of risks, such as aseptic necrosis, the bone deterioration which afflicted Cindy," he said. "And it's never been tested in a large-scale clinical trial."
Nelson is studying treatment with a shorter term, low dose of prednisone, and is currently seeking additional patients. Patients should be between 18 and 39 years of age, and be interested in becoming pregnant. Women interested in participating may contact Nelson at NICHD's Developmental Endocrinology Branch, Bldg. 10, Rm. 10N262, 6-4686.
"I applaud his work," Cindy said. "It's in a controlled setting, it doesn't use large doses of drugs that have never been fully tested. I'm glad that Dr. Nelson is doing the research he's doing."
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