Ovary Transplant to Arm a Success

Researchers report second-ever transplant of entire organ

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HealthDay Reporter

MONDAY, Nov. 8, 2004 (HealthDayNews) -- Surgery to transplant a woman's entire ovary to her upper arm is feasible and can preserve fertility in patients undergoing radiation treatments that leave them prematurely menopausal, a new report says.

The report, by researchers from the Netherlands and South America, describes the second successful human ovarian "autotransplant." The technique could provide hope to the thousands of women who suffer from cancer and become infertile when they undergo radiation treatments that damage their ovaries, the scientists said.

The researchers performed a transplant that was a bit different from the first such transplant, which was done in 1987 and did not result in a pregnancy. Dr. Carina Hilders, lead author of the report and a physician at the Leiden University Hospital in the Netherlands, said the new method doesn't require developing a "donor site" -- or pocket -- in the arm, which was done for the first transplant and took several months. The new method can be done at the time of the treatment for cancer, Hilders said.

"So no delay in treatment [occurs]," she said, "and it is a technically feasible procedure.

The report appears in the Nov. 8 online edition of the journal Cancer.

However, several transplant experts are taking a wait-and-see attitude with the new findings. They include Dr. Kutluk Oktay, a pioneer in ovarian tissue transplant, and an associate professor of reproductive medicine at Weill Medical College of Cornell University in New York City.

"This approach is only feasible for a woman who is going to receive only radiation to the ovarian area, not for a woman who gets chemotherapy, because chemo reaches the ovaries regardless of where they are placed," Oktay said.

Other researchers, including those in the United States, have done ovarian transplants to the arm to preserve fertility. But they removed strips of ovarian tissue before the cancer treatment, froze them, and then transplanted them years later, Hilders noted.

For example, in September 2004, a Belgian woman gave birth to a healthy girl after her ovarian tissue had been transplanted back into her. She had "banked" frozen pieces of ovarian tissue after undergoing chemotherapy and radiation in 1997 following a diagnosis of Hodgkin's lymphoma.

Transplanting the entire organ eliminates the need for freezing, or cryopreservation, experts said. And it may result in a better blood supply.

In their operation, Hilders and her team removed the woman's ovary with some blood vessels attached and transplanted it into the upper arm, connecting the ovarian blood vessels to the existing blood vessels in the arm.

The 29-year-old woman, from Suriname, South America, had cervical cancer and had been referred to the Leiden University Medical Center.

Hilders said the woman's ovarian function has been maintained for more than a year, but she has not become pregnant. Longer follow-up is needed to prove the long-term feasibility of the approach. The hope is that eggs could be retrieved from the transplanted ovary and then fertilized "in vitro" -- in a laboratory, she said.

"It seems very likely that ovarian autotransplantation will be a realistic goal to achieve for women with cancer who receive high-dose pelvic radiotherapy," Hilders said. "Autotransplantation will preserve reproductive and hormonal function, thereby substantially improving the patients' quality of life after treatment."

Another expert, Dr. Craig Witz of the University of Texas Health Science Center at San Antonio, said that the new report is "cutting edge," but noted that preservation of a woman's fertility after cancer treatment is an evolving science.

"The best approach has not yet been established," said Witz, chief of the division of reproductive endocrinology and infertility at the university. He also serves on several committees for the American Society for Reproductive Medicine.

"The ASRM is clear on this: This is all considered experimental therapy at present," he said. "However, there are enough centers around the country with the surgical expertise to attempt these sorts of surgical and experimental approaches that the patient should ask."

Women who still hope to have children should ask their doctor about what options might be available to preserve fertility, Witz said.

More information

To learn more about infertility, visit the American Society for Reproductive Medicine.

SOURCES: Carina Hilders, M.D., Ph.D., physician researcher at Reinier de Graff Hospital and Leiden University Hospital, the Netherlands; Craig Witz, chief of the division of reproductive endocrinology and infertility, and the Frank Harrison Chair in Reproductive Medicine, University of Texas Health Science Center at San Antonio; Kutluk Oktay, M.D., associate professor of reproductive medicine at Weill Medical College of Cornell University, New York City, Nov. 8, 2004, online edition, and Dec. 15, 2004, print edition, Cancer

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