HKUMed and HKU Shenzhen Hospital achieve breakthrough in treating premature ovarian insufficiency with drugs to activate dormant eggs and restore fertility

A research team from the Department of Obstetrics and Gynaecology at the School of Clinical Medicine, LKS Faculty of Medicine, the University of Hong Kong (HKUMed), has made a major breakthrough in treating premature ovarian insufficiency (POI). The team discovered that finerenone, a drug used to treat type 2 diabetes-related chronic kidney disease, can promote the development of follicles into mature eggs and form viable embryos in patients with POI. In contrast to traditional strategies focusing solely on direct follicle stimulation, this pioneering study is the first to focus on improving the ovarian microenvironment to treat infertility caused by POI.

HKUMed reveals that using drugs to treat POI by awakening dormant eggs and facilitating their development into usable antral follicles, is a key breakthrough in restoring fertility (from left: Professor William Yeung Shu-biu, Professor Ernest Ng Hung-yu and Dr Wang Tianren). Photo source: HKUMed

A related clinical trial conducted at the University of Hong Kong-Shenzhen Hospital (HKU-SZH) confirmed that the participants experienced significant improvement in follicle development. About half of the participants successfully produced mature eggs, several of which developed into viable embryos. The results confirmed that this ground-breaking approach can restore fertility for women affected by POI. The research findings were published in the prestigious scientific journal Science.

POI affects approximately 1-3% of women of childbearing age worldwide. These patients have difficulty conceiving because of lack of ovarian follicular development. Under normal circumstances, small ovarian follicles develop gradually into larger antral follicles, which respond to ovarian stimulation drugs, enabling ovulation and in vitro fertilisation (IVF) treatment. However, patients with POI often lack antral follicles that can be detected by ultrasound, rendering conventional IVF treatment almost impossible.

A new strategy to improve the ovarian microenvironment to awaken dormant small follicles

There may still be a small number of small dormant follicles in the ovaries of patients with POI. However, they cannot develop naturally into the antral follicle stage, which is essential for ovulation and fertility treatments. Professor Liu Kui from the Department of Obstetrics and Gynaecology at the School of Clinical Medicine of HKUMed, who led the research, said, 'These small follicles represent a source of potential eggs. The key is finding a way to awaken them and help them develop into usable antral follicles.'

The research team adopted the 'drug repurposing' strategy to explore novel treatment for POI-related infertility using drugs that have been approved and backed by established clinical safety data. Professor Liu noted that this method can avoid the lengthy and costly process involved in developing new drugs from scratch and can significantly accelerate the translation of the new treatment for clinical use. Leveraging the previous in-depth research into the regulatory mechanism of ovarian follicle development, the team established a systematic screening platform and selected finerenone, a non-steroidal antifibrotic drug from a library of over a thousand drugs approved by the US Food and Drug Administration (FDA). The team found that finerenone has potential clinical value in improving the ovarian microenvironment and facilitating the development of small dormant follicles.

Professor Ernest Ng Hung-yu, Clinical Professor in the Department of Obstetrics and Gynaecology at the School of Clinical Medicine, HKUMed, explained, 'Patients with POI often experience fibrosis, characterised by an excessive deposition of collagen in the ovarian microenvironment, which severely limits follicle growth and ultimately leads to infertility. We found that finerenone effectively reduces fibrosis, creating a favourable microenvironment for the continuous development of follicles into mature antral follicles.'

Professor Ernest Ng Hung-yu remarks that patients with POI often experience fibrosis in the ovarian microenvironment, which severely limits follicle growth and leads to infertility. However, finerenone effectively reduces fibrosis, creating a favourable microenvironment for the continuous development of follicles into mature antral follicles. Photo source: HKUMed

The research team launched a clinical trial at HKU-SZH in 2024, providing pulsed oral therapy to 14 women of childbearing age diagnosed with POI. The therapy was combined with personalised ovarian stimulation regimens for up to seven months. Dr Wang Tianren, Clinical Assistant Professor from the same Department, said, 'Preliminary results showed that eight participants successfully developed antral follicles that progressed to mature follicles. About half of the participants obtained mature eggs. Three participants developed usable embryos, and another three opted to freeze their oocytes. The treatment results were highly encouraging.'

Ovarian fibrosis is a cause of follicular development arrest

This study also revealed the underlying pathological mechanism of follicular development arrest in POI. The team found that ovarian fibrosis is not caused solely by ageing. It is also a key factor leading to the stagnation of follicular development. To verify this, the team tested multiple antifibrotic drugs with different targets to redefine the initiation and growth mechanism of primordial follicles from the perspective of the 'ovarian microenvironment'. They proposed a new treatment framework for POI based on these findings. In addition, the study confirmed that other FDA-approved antifibrotic drugs, such as Nintedanib and Ruxolitinib, had similar effects in promoting follicular development in preclinical studies. This suggests that treatments targeting the ovarian microenvironment, rather than just the follicles, may have potential in broader clinical application.

Professor Liu Kui stated, ‘In the past, treatments for POI-related infertility focused mainly on directly stimulating the follicles, but the overall efficacy was limited. Our study is the first to show that improving the ovarian microenvironment, especially by addressing fibrosis, is a key breakthrough in restoring fertility.'

Professor Liu Kui (middle, front row) from the Department of Obstetrics and Gynaecology at the School of Clinical Medicine, HKUMed, who led the research team, states that improving the ovarian microenvironment, especially by addressing fibrosis, is important for treating POI-related infertility. Photo source: HKUMed

About the research team

The study was led by Professor Liu Kui from the Department of Obstetrics and Gynaecology at the School of Clinical Medicine, HKUMed. The research team includes Professor Ernest Ng Hung-yu, Clinical Professor, Professor William Yeung Shu-biu, Emeritus Professor, Dr Wang Tianren, Clinical Assistant Professor, and PhD student Lin Zexiong, from the same department; as well as Dr Li Yu, Chief of Service, and Dr Li Yuan, postdoctoral fellow, from the Reproductive and Prenatal Diagnostic Medicine Centre at HKU-SZH.

Acknowledgements

This study was conducted in collaboration with HKU-SZH, which served as a clinical research partner. It received funding support from the Shenzhen Science and Technology Innovation Committee.

STANFORD, Calif. (AP) — Dr. Karl Deisseroth spent hours fielding congratulatory calls after learning early Monday that he had won a Nobel Prize for medicine for helping to open a new field of brain science called optogenetics.

But it wasn't long before the California scientist asked for a break from all the attention for a more ordinary task: He needed to make school lunches for his children, who were asleep in the family home in Stanford, where their father had been speaking in the middle of the night with journalists and well-wishers.

Deisseroth, 54, shared this year’s medicine prize with two researchers in Germany for their work in optogenetics, a field that combines light with genes to switch on and off neurons in living brains.

A self-described night owl, the Howard Hughes Medical Institute investigator and Stanford University professor often works past midnight. After reviewing papers and emailing his students, he said he had just gone to lie down when he got the call from the Nobel Assembly in Stockholm.

“I almost felt as if I’d lost the power of forming words,” he told The Associated Press, “but I recovered after a minute or two.”

He regained speech quickly enough for remote interviews with AP science reporters. Speedy emails with the Stanford communications staff had helped put them in touch.

“No real sleep was achieved,” he said an hour after the announcement.

As the science reporters chatted with Deisseroth over the phone and Zoom, an AP photographer and videographer raced to his home in Stanford.

The photographer arrived around 3:30 a.m. to find Halloween decorations outside the home but just one light on inside. He was worried he had the wrong house before mustering the courage to knock on the door.

Dr. Michelle Monje-Deisseroth, the scientist's wife, answered and ushered the photographer into their home, where the Nobel winner was taking calls from the couch.

Monje-Deisseroth, an HHMI investigator and Stanford pediatric neuro-oncologist, was at his side when she wasn’t making coffee for the Stanford communications staff who had joined the celebration. Deisseroth was surprised to hear his work had been honored with a Nobel Prize, he told the AP, but his wife was not.

Deisseroth recounted the research he conducted with fellow Nobel winners Peter Hegemann and Georg Nagel, and its real-world impact.

“For me, I’m a physician-scientist. I am a psychiatrist. I care about patients and my patients who have autism, who have depression,” he said. “I care about the hope that this brings. But I’m also a basic scientist, and I care about understanding this amazing organ, the brain, and how it works and how it integrates and computes and delivers all the things that make us human.”

As Deisseroth wrapped up the interviews, he told the Stanford staff he needed an hourlong break beginning at 6:30 a.m. His kids would be waking up, he said, and they would need lunches before leaving for school.

When one of the Stanford representatives wondered if the neighbors would mind all the late-night commotion, Monje-Deisseroth shrugged it off.

They live in faculty housing, she said. There are a lot of Nobels in the neighborhood.

__

Ramakrishnan reported from New York. Associated Press writers Stefanie Dazio in Berlin and Lauran Neergaard in Washington contributed to this report.

AP Nobel Prizes: https://apnews.com/hub/nobel-prizes

Karl Deisseroth, one of the three recipients of the 2026 Nobel Prize in medicine, poses for a photo on Monday, Oct. 5, 2026, in Stanford, Calif. (AP Photo/Noah Berger)

Karl Deisseroth, one of the three recipients of the 2026 Nobel Prize in medicine, talks on his mobile at home on Monday, Oct. 5, 2026, in Stanford, Calif. (AP Photo/Noah Berger)

Karl Deisseroth, one of the three recipients of the 2026 Nobel Prize in medicine, smiles at home on Monday, Oct. 5, 2026, in Stanford, Calif. (AP Photo/Noah Berger)

Karl Deisseroth, one of the three recipients of the 2026 Nobel Prize in medicine, talks to his wife Michelle Monje-Deisseroth at home Monday, Oct. 5, 2026, in Stanford, Calif. (AP Photo/Noah Berger)