First-Ever Birth After Ovarian Transplant

Alabama woman delivers girl after receiving graft from twin sister, scientists say

TUESDAY, June 7, 2005 (HealthDayNews) -- In a first, an American team reports that a previously infertile, 24-year-old woman who received an ovary transplant from her identical twin sister has gone on to give birth to a healthy baby.

Stephanie Yarber of Muscle Shoals, Ala., gave birth Monday night to a daughter after receiving the transplant last year from her sister, Melanie Morgan, according to news reports.

Ovarian transplant is a new method of restoring fertility to women whose ovaries are not functioning normally. However, it is an invasive procedure and carries risks similar to any organ transplant.

While the procedure took place between identical twins, which avoids potential tissue-rejection issues, experts expect it might eventually work in the broader population.

"We will probably be doing more of that in the future," said Dr. Hugh Taylor, an assistant professor of reproductive endocrinology and infertility at Yale University School of Medicine. "This will include ovarian freezing for women undergoing chemotherapy and other procedures that can result in the loss of ovarian function," he added.

The breakthrough was reported in an article released Tuesday by the New England Journal of Medicine to coincide with the birth. The report will appear in print in the July 7, 2005, issue.

The transplant team was led by Dr. Sherman Silber, of St. Luke's Hospital, in St. Louis.

According to the report, Yarber's ovaries began functioning abnormally when she was 14. Her twin sister had normally functioning ovaries and bore three children, all of whom were conceived naturally.

The sterile twin tried egg-donation therapy, which was not successful. With an ovary donated by her sister, doctors transplanted ovarian tissue into the sterile sister's ovaries.

Within three months of transplantation, the sterile sister's menstrual cycles returned and during the second cycle she conceived. After a normal 38-week pregnancy she gave birth to a healthy girl, the researchers reported.

Because the sisters were identical twins, there was no fear of tissue rejection or other problems, which are common in other transplants.

"Although ovarian transplantation between monozygotic (identical) twins will be rare, the demonstration that ovarian function can be restored and that natural conception and successful pregnancy can be achieved after transplantation of ovarian tissue may have broader implications for preserving fertility in young women, such as those who require potentially sterilizing treatment for cancer," the authors concluded.

The technique has the potential to change the way women think about childbearing, Taylor said. He speculated that women who wish to delay having children might want to have their ovaries frozen, to be transplanted at a later time.

"Ovarian transplantation can serve as a prophylaxis against aging and diminishing ovarian function as women pursue careers, etc., delaying child bearing," he explained.

By removing a piece of their own ovary and freezing it, that tissue can be transplanted at a later date without fear of rejection and potentially restore fertility, Taylor noted.

"I think the potential is huge," he said. However, he stressed that this report doesn't prove that the egg really came from the donated ovary. "This has been a problem with the other reports of pregnancy from ovarian transplant."

The Yale expert also noted that premature ovarian failure spontaneously reverts in about 5 percent to 10 percent of cases.

Most important, while the use of ovarian transplantation will no doubt grow in the future, it won't replace egg donation, which is highly successful and not nearly as invasive as a transplant, Taylor said.

"Where ovarian transplantation will come into play is with somebody who knowingly wants to preserve their fertility," he said. "It could be because they are having radiation treatments, or they know they are going to put off childbearing for many years. This is the future of fertility preservation."

Another expert was more cautious. "It's a remarkable thing that was done, but it's not something that is going to help a lot of patients," said Dr. Jaime A. Grifo, director of the Division of Reproductive Endocrinology at New York University Medical Center and a professor at the NYU School of Medicine. "Not many people with ovarian failure have a twin sister."

As for women who are having cancer treatment, Grifo is skeptical of how useful freezing ovarian tissue will be. "The problem is: what cancer are you talking about?" he said. "If you're talking about ovarian cancer, it's not an option. If you are talking about other cancers, you still wonder if that will have any impact on their cancer."

Safer techniques would be freezing eggs or embryos, Grifo said.

As for preserving fertility over time, Grifo thinks the technique is too invasive to make that practical. "It's pretty invasive for that," he said. "And to freeze the tissue and have it function, well, that hasn't been done."

More information

The American Society of Reproductive Medicine can tell you more about infertility.

SOURCES: Hugh Taylor, M.D., assistant professor of reproductive endocrinology and infertility, Yale University School of Medicine, New Haven, Conn.; Jaime A. Grifo, M.D., Ph.D., director, Division of Reproductive Endocrinology, New York University Medical Center, and professor, NYU School of Medicine, New York City; July 7, 2005, New England Journal of Medicine
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