This new case raises hope for successful reproduction among women who’ve undergone ovary transplantation surgery
Though there have been previous cases of successful pregnancies after ovarian tissue from adulthood had been transplanted, until now, there have not been any in which tissue taken from girls before puberty has yielded successful results.
Dr Isabelle Demeestere, a gynaecologist and research associate at Erasme Hospital in Belgium, says this is an important result, “because children are the patients who are most likely to benefit from the procedure in the future.”
The patient, who remains anonymous, was born in the Republic of Congo and diagnosed with sickle-cell anaemia when she was 5 years old. When she emigrated to Belgium at age 11, her doctors felt she needed to have a bone marrow transplant, given the severity of her disease.
Because her
immune system needed to be disabled before transplantation to avoid bone marrow rejection, the doctors needed to treat her with chemotherapy, which can permanently destroy the ovaries. Before doing so, they removed her right ovary (when she was nearly 14 years old) and froze tissue fragments.
So what made her transplantation a success?
The transplanted tissue successfully responded to the patient’s hormones
Although there were signs that the patient had started puberty when she was 10 – as her breasts were beginning to develop – she had not started her periods.
After a successful bone marrow transplant, the patient developed graft-versus-host disease and, therefore, had to stay on immunosuppressive drugs for 18 months more. When she was 15, her left ovary failed, so doctors administered hormone replacement therapy to induce menstruation.
Fast forward 10 years, and the patient expressed a wish to become pregnant. To restore fertility, Dr Demeestere stopped the hormone replacement therapy and thawed some of the frozen ovarian tissue from the patient's childhood. After grafting four fragments on to the remaining left ovary, Dr Demeestere then grafted 11 other fragments elsewhere in the body.
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The patient's transplanted tissue began to respond to her hormones and began growing follicles containing mature eggs. Five months later, the patient started menstruating and had regular cycles from then on.
Two years after the transplantation, at the age of 27, the patient became pregnant naturally, and in November 2014, she delivered a healthy baby boy. Doctors say her ovary has continued to function normally and that there is a high likelihood she could have more babies in the future.
But researchers say they need to investigate further into ovary-destroying procedures
Dr Demeestere says when children have diseases that call for ovary-destroying treatment, freezing the ovarian tissue "is the only available option for preserving their fertility."
She says this they need to investigate the procedure further, however, because their patient had already started puberty, despite the absence of a first period. There are also some “controversial issues,” as Dr Demeestere explains:
“For instance, because it is an invasive procedure and because the lifespan of the graft is limited, should it be used to induce puberty and menstruation, rather than to restore fertility, when hormone replacement therapy is an efficient, standard and non-invasive alternative for inducing puberty? Should the procedure only be proposed for patients with a high risk of ovarian failure or those at low risk as well?”
She answers that she and her team think they should only use frozen ovarian tissue to restore fertility in those patients at high risk of ovarian failure, not for inducing puberty or restoring adult menstrual cycles.
But Dr Demeestere says that because they did not transplant all of the patient's ovarian tissue the first time, she could undergo a second transplantation if the graft stops working.
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