Can immune therapy restore fertility in premature ovarian insufficiency?

August 5, 2026

A recently published study in *New England Journal of Medicine Evidence,* and led by professor Olle Kämpe at CMM, suggests that immunotherapy could help restore fertility in some women with premature menopause due to autoimmune disease, offering new hope for patients who have long faced limited treatment options.

Premature ovarian insufficiency (POI) is a condition in which ovarian function declines before the age of 40. Affecting around 3.5% of women worldwide, it is characterized by reduced estrogen production, irregular or absent menstrual periods, and infertility. Women with POI may also experience symptoms commonly associated with menopause, such as hot flushes, and face increased long-term risks of osteoporosis, cardiovascular disease, and cognitive decline. For many patients, the diagnosis can be particularly distressing because fertility is often severely compromised.

In most cases of POI the causes remain unknown. However, research suggests that up to one-third of patients have an autoimmune form of the disease, in which the immune system mistakenly attacks ovarian tissue. Current treatment mainly focuses on hormone replacement to relieve symptoms and protect long-term health. While spontaneous recovery of ovarian function occasionally occurs, there are currently no established treatments that reliably restore fertility.

A recent proof-of-concept study has raised the possibility that immune-targeted therapy could change this situation. Researchers at CMM and Karolinska Institutet investigated rituximab, a monoclonal antibody that depletes B lymphocytes and is widely used to treat certain autoimmune diseases. Ten women with autoimmune POI underwent ovarian hyperstimulation before and after receiving two rituximab infusions.

Professor Olle Kämpe, Group Leader at CMM and last author of the study. Photo: Private.

Before treatment, none of the participants responded with follicular development to ovarian stimulation. Four to six months after rituximab treatment, six of the ten women developed follicles sufficient for egg retrieval. In three of these cases, retrieved eggs were successfully fertilized, embryos were preserved, and pregnancies were later achieved. In addition, eight of the ten women experienced at least a temporary return of menstrual cycles, suggesting partial restoration of ovarian activity.

Although the study involved only ten women and requires confirmation in larger clinical trials, the results are highly encouraging. For a condition long considered largely irreversible, immune-based therapy offers a promising new approach. If future studies confirm these findings, treatments such as rituximab could potentially restore ovarian function and improve fertility prospects for women with autoimmune POI.

Publication:

Immunotherapy for Fertility in Autoimmune Premature Ovarian Insufficiency. Hirschberg, A.L., Björnsdottir, S., Gunnarsson, I., Sergouniotis, F., Wånggren, K., Sousa Silva, C., Vogt, E., Øksnes, M., Husebye, E.S., Bensing, S. and Kämpe, O. (2026). NEJM Evidence, 5(7). doi:https://doi.org/10.1056/evidoa2500303.