Quote · The Peter Attia Drive
#397 ‒ Endometriosis and adenomyosis: diagnosis, fertility, reproductive aging, and emerging treatments | Renato Tomioka, M.D., Ph.D.
Where this was said
Emerging fertility technologies: mitochondrial replacement, ovarian tissue preservation, stem-cell-derived eggs, and current limitations
At 1:34:50 · chapter starts 1:32:29
Peter invites Tomioka to survey the technology horizon for women who want to use their own genetic material at advanced age. Mitochondrial replacement therapy, developed for mitochondrial disease and published in the New England Journal of Medicine by a Newcastle group, transfers nuclear material (pronuclei) into an enucleated donor egg to replace defective mitochondria — but the chromosomes, the actual source of age-related aneuploidy, remain the patient's own. [1] — Renato Tomioka "Mitochondrial replacement therapy swaps the cytoplasm around the nucleus but doesn't fix the chromosomes — the actual source of age-related…" 1:33:40 Tomioka bluntly labels clinics in North Cyprus and Greece selling this as 'egg rejuvenation' as misleading: 'It's a battery swap for the egg, but you're not changing the engine.' Ovarian cortex cryopreservation — freezing a slice of ovarian tissue in one's 30s and reimplanting it at 45 — is theoretically capable of postponing menopause by 10 to 15 years but lacks clinical data and is arguably inferior to standard hormone replacement therapy. [2] — Renato Tomioka "If pluripotent stem cells can be reliably converted into functional, chromosomally normal eggs, age becomes irrelevant to fertility. It has…" 1:36:30 The most transformative technology on the horizon is stem-cell-derived eggs: pluripotent stem cells converted into functional oocytes. It has been demonstrated in mice with normal offspring. Tomioka estimates clinical reality is about 10 years away, at which point age becomes largely irrelevant to fertility. He closes with a nuanced caution about IVF itself: Louise Brown, the first IVF baby, is only 48. Epigenetic effects of fertilization outside the fallopian tube remain uncharacterized, and selection bias makes epidemiological studies hard to interpret.
Mitochondrial replacement therapy swaps the cytoplasm around the nucleus but doesn't fix the chromosomes — the actual source of age-related infertility. Clinics in North Cyprus and Greece are marketing this as egg rejuvenation. It isn't. The engine is still old; you just changed the battery.
If pluripotent stem cells can be reliably converted into functional, chromosomally normal eggs, age becomes irrelevant to fertility. It has been done in mice with normal offspring. Larger animals are next. Renato Tomioka estimates 10 years to clinical reality — and when it arrives, egg freezing becomes obsolete.
The first IVF baby was born in 1978. Louise Brown is 48. We have no idea what IVF-conceived people look like at 60 or 70. There may be epigenetic effects from fertilization outside the fallopian tube that we simply cannot yet measure. For couples who can conceive naturally, Tomioka still recommends trying.
