Woman Gives Birth After Ovarian Tissue Transplant

Chemotherapy had left 28-year-old Israeli unable to conceive

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By
HealthDay Reporter

MONDAY, June 27, 2005 (HealthDay News) -- A 28-year-old Israeli woman whose ovaries were effectively destroyed by high-dose chemotherapy for cancer has given birth to a healthy baby girl after doctors transplanted some of her own frozen ovarian tissue.

This appears to be the first time scientists have managed to preserve fertility by freezing ovarian tissue and then transplanting it in humans, the researchers said.

Details of the procedure will appear in the July 21 issue of the New England Journal of Medicine, but were released Monday to coincide with the birth of the baby.

This new report offers hope to the millions of younger women who face losing their fertility after chemotherapy. And the Israeli doctors think the techniques they used may also be able to help preserve fertility in older women.

"I'm very curious what will be the ovarian function [in the 28-year-old woman] from now. Will it keep on going?" said study senior author Dr. Jehoshua Dor, director of the In Vitro Fertilization (IVF) Center at Chiam Sheba Medical Center in Tel Aviv.

"If yes, then it can also be a sort of a therapy to postpone menopause in the future. Maybe we can use it also in benign situations like severe endometriosis. I think there are a lot of possibilities. But, meanwhile, we should be careful and look at the first cases and learn more about it," Dor added.

Loss of ovarian function is a very real concern for premenopausal women who have high-dose chemotherapy treatment.

Scientists have managed to preserve fertility in animals by freezing ovarian tissue and then transplanting it back into the animal. In humans, however, success had been elusive.

In earlier attempts, eggs that were taken from frozen ovarian tissue and transplanted did not result in pregnancy, the Israeli researchers reported.

One woman who had lost ovarian function after treatment for Hodgkin's disease had a baby, but, because the woman had ovulated before transplantation of the tissue, it was never clear if the egg came from the original ovary or the transplanted tissue. And one woman who was sterile gave birth after receiving ovarian tissue from her identical twin sister.

The Israeli woman highlighted in the new report initially underwent two unsuccessful courses of conventional chemotherapy for non-Hodgkin's lymphoma. Before attempting a high-dose regimen, she asked that ovarian tissue be removed and frozen.

"I wasn't so keen about it because she had already had two chemotherapy courses, but she persisted," Dor said.

After the next phase of high-dose treatment, the women recovered from her cancer but effectively went into menopause.

The woman did not have a period for the next two years, and hormone levels indicated her ovaries had failed. At two years, the woman requested ovarian tissue transplantation in an attempt to restore fertility.

Strips of thawed tissue were transplanted into the left ovary and fragments were injected into the right ovary. Only the strips placed in the left ovary "took," according to the report.

Eight months after the procedure, the woman menstruated and hormone levels indicated the presence of active, early stage, growing follicles, or eggs.

One month later, the woman had a second menstrual cycle.

Doctors then performed in vitro fertilization, fertilizing an egg from the woman with sperm from her husband. Two days later, a four-cell embryo was transferred to the uterus.

A baby girl weighing 6.6 pounds was delivered by Caesarean section. The authors felt it unlikely that the egg came from the "native ovary," given the earlier evidence of failure.

Dor attributed the success to transplanting the tissue into the ovaries themselves.

"I thought that transplantation should be done in the ovary itself, not under the skin, not in the abdominal wall, not under the skin of the arm," he said. "People were scared that the ovaries following chemo were damaged. This is correct, but the follicles are damaged, not the blood supply. The blood supply is good enough to allow the implants to develop and to function."

More information

The American Society of Reproductive Medicine can tell you more about in vitro fertilization.

SOURCES: Jehoshua Dor, M.D., director, In Vitro Fertilization Center, Chiam Sheba Medical Center, and professor, obstetrics and gynecology, Sackler School of Medicine, Tel Aviv University, Israel; July 21, 2005, New England Journal of Medicine

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