Slowing the Biological Clock

For years researchers believed that women were born with all the eggs they would ever have. That—and the fact that the quality of the eggs diminishes when a woman reaches her 40s—meant infertility was inevitable past a certain age. But in 2004, Jonathan Tilly and other researchers at Massachusetts General Hospital showed that ovaries also contain egg precursor cells, which might, in theory, mature into new eggs or boost the health of existing ones. Now OvaScience, which Tilly cofounded—a member of this year’s 50 Smartest Companies list—is developing treatments for infertile couples. In its first commercially available approach, energy-producing mitochondria are transferred from egg precursor cells into mature eggs to rejuvenate them. These eggs are then used for in vitro fertilization. In May, the first baby was born to parents who tried this approach. OvaScience CEO Michelle Dipp spoke with MIT Technology Review contributing editor Amanda Schaffer.

What need does OvaScience’s technology address that regular in vitro fertilization does not?

One in six couples worldwide struggles with infertility, and unfortunately, the standard of care, which is IVF, often fails. Our goal is to address the root cause of infertility and the reason treatment fails, which is frequently unhealthy eggs. We now know that women have egg precursor cells in the outer lining of our ovaries. We are developing several treatments that use these precursor cells. In one treatment, which is now on the market, we add mitochondria to eggs. In another approach, which is still experimental, we move egg precursor cells to the middle of the ovary so that they grow into eggs during IVF. In a third treatment [also experimental], we take the precursor cells and grow them into eggs outside the body.

Should these treatments change the way we think about the biological clock?

As a woman gets older, she still has these fresh, young, healthy egg precursor cells. These cells don’t seem to age with time, because they’re in an area that lacks a good blood supply, so they lie dormant. I do think that discovery should change our assumptions about fertility and aging.

So how late in life could a woman get pregnant?

It ends up being a doctor-patient conversation about what age they do IVF, and most clinics have certain ways to think about what their age cutoff is. Usually around the time of menopause, it becomes a lot more challenging. Women have to use other hormones in addition to IVF to get pregnant.

Do you see a limit on how many people could benefit from this technology?

More women are waiting to start families. When you look at emerging markets, like in Latin America and the Middle East, more women are going to college, more of them are seeking advanced degrees, more of them are traveling to other countries to get those advanced degrees. They’re prioritizing other things. [Because they’re older when they try to have children] there’s an increase in infertility as well as in IVF rates, and the demand is expected to be even greater in the future. The global market is projected to reach over $20 billion by 2020.

This treatment is expensive—$15,000 on top of the cost of IVF. Won’t cost place an important limit on patient access?

It already does with IVF. Many more couples are infertile than seek treatment, because it is paid for out of pocket. [But] a number of doctors offer IVF pro bono in countries where it is hard for patients to gain access.

Your first treatment is not available in the United States. Is the future of the company mainly in other countries?

That’s certainly what the market has always dictated in the past. The growth rate of IVF in Europe is about 10 percent. There is no growth in the U.S. That said, the goal is to bring our treatments to women everywhere, and that includes the U.S. But I’m afraid I can’t comment on what we would need to do to win regulatory approval here.

How strong is the evidence that your treatment works, considering the absence of randomized controlled trials?

New data show that women who failed previous IVF treatment and then used our approach increased their chance of having a child. We’re really excited about that. Because these women had tried IVF already, they served as their own controls.

Fertility treatments are not drugs. Drugs are of course analyzed by a randomized controlled trial, but these are surgical procedures.