Ovarian Tissue Transplant Patient Gives Birth, NEJM Reports; Doctors Caution Procedure Not Solution to Infertility

Main Category: Fertility
Article Date: 15 Jun 2005 - 4:00 PDT

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A 24-year-old Alabama woman who last year underwent an ovarian transplant using tissue donated from her identical twin sister gave birth to a healthy infant on Monday, making her the first U.S. woman to carry an infant to term following such a procedure, according to a report posted on Tuesday in the online edition of the... New England Journal of Medicine, USA Today reports (Rubin, USA Today, 6/8). A team of doctors in April 2004 successfully removed an ovary from Melanie Morgan and transplanted it into her identical twin sister, Stephanie Yarber, who began experiencing menopause at age 14 and was unable to conceive naturally or through in vitro fertilization using donated eggs from Morgan. Doctors at St. Luke's Hospital in St. Louis microsurgically sutured the outer tissue of the donated ovary -- which contains egg-producing follicles -- to each of Yarber's nonfunctioning ovaries (Kaiser Daily Reproductive Health Report, 4/26/04). Yarber had a menstrual period 80 days after the transplant, and an ultrasound exam 176 days after the transplant showed she was pregnant, USA Today reports (USA Today, 6/8). Researchers say they are almost certain the pregnancy resulted from an egg produced by the donated ovarian tissue because Yarber's own ovaries were not producing eggs and she had not menstruated since age 14 (Pagan Westphal, Wall Street Journal, 6/8). A complete article about the procedure is expected to be published in the July 7 issue of NEJM (Grady, New York Times, 6/8).

Report Details
"Although ovarian transplantation between [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," Sherman Silber -- director of the Infertility Center of St. Louis at St. Luke's Hospital, who performed the ovarian transplant surgery -- and colleagues conclude in the online report (Silber et al., NEJM, 6/7). More than 80% of fertile women who undergo chemotherapy for cancer treatment become infertile and experience premature menopause, according to the Journal. However, if healthy ovarian tissue could be taken from these women and frozen before chemotherapy begins, researchers say it could be possible to reinsert the tissue after treatment to allow continued menstrual cycles and egg production (Wall Street Journal, 6/8). The report "should give encouragement to the hundreds of women ... who are banking on their ovarian tissue to give them a chance of giving them natural childbirth in the future," Roger Gosden, a physician and reproductive biology professor at Weill Medical College of Cornell University who helped treat the sisters, said (Ubelacker, Globe and Mail, 6/8).

Ramifications
The report also "raises the possibility" that the technique could be used to help women who are unable to conceive following IVF attempts, according to the Journal. However, the transplant technique is more invasive and is so new that no studies have compared the methods, the Journal reports (Wall Street Journal, 6/8). In addition, Yarber's success is unique among infertile women because she has an identical twin, the Los Angeles Times reports (Maugh, Los Angeles Times, 6/8). For that reason, doctors warn that Yarber's success will not lead to widespread use of ovarian tissue transplant as a cure for infertility because the great majority of people do not have an identical twin donor, the New York Times reports. When a donor and recipient are not a perfect genetic match, the recipient would have to take antirejection drugs, which could cause harsh side effects and raise ethical questions about the necessity of the procedure. "But one day, no doubt, the rejection problem will be overcome and we won't need the drugs, or we won't need them for long," Gosden said, adding, "Then the procedure could be used very widely and will replace a lot of conventional egg donation" (New York Times, 6/8).

ABCNews' "World News Tonight" on Tuesday reported on the transplant. The segment includes comments from Gosden, Morgan and Yarber (Potter, "World News Tonight," ABCNews, 6/7). A video excerpt of the segment is available online in RealPlayer.

"Reprinted with permission from kaisernetwork.org kaisernetwork.org. You can view the entire Kaiser Daily Reproductive Health Report, search the archives, or sign up for email delivery at www.kaisernetwork.org/dailyreports/repro The Kaiser Daily Reproductive Health Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

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