Woman gives birth after pioneering ovarian tissue transplant

[jimmy olsen]

I know some girls devasted by the fact that their treatment has left them infertile. I don't think this is an option for them, but I'm very happy to see that in the future this will no longer be the case.


http://www.theguardian.com/science/2015/jun/10/woman-gives-birth-after-pioneering-ovarian-tissue-transplant

Woman gives birth after pioneering ovarian tissue transplant

Ovarian tissue frozen when patient underwent chemotherapy as a teenager successfully grafted onto remaining ovary, allowing natural conception
 
Wednesday 10 June 2015 00.05 BST  Last modified on Wednesday 10 June 2015 00.06 BST 

Ovum in fallopian tube 
An ovum in the fallopian tube. The procedure had been used before with adult tissue, but never with immature tissue. After five months the patient was ovulating. Photograph: Science Picture Co/Getty Images/Science Faction

Hannah Devlin

A young woman in Belgium has become the first to give birth to a healthy baby after having her fertility restored by a transplant of ovarian tissue that was removed and frozen when she was a child.

The pioneering treatment could lift the spectre of infertility for girls who undergo harsh chemotherapy or radiotherapy treatments at a young age when they do not yet have mature eggs that can be stored for use in the future.

The 27-year-old patient, who has asked to remain anonymous, gave birth to a healthy boy in November and was said to be overjoyed after suffering years of anxiety about her fertility since undergoing chemotherapy as a 13-year-old.

Isabelle Demeestere, the gynaecologist who led the trial at Erasme Hospital in Brussels, said: "This was like a victory for her, she was so happy after living with that uncertainty for years."

The successful treatment could pave the way for fertility to be restored in many more women who until now have been unable to have children after being given medical treatments that caused damage to their ovaries, the scientist added.

"It's the only option available for these children," said Dr Demeestere. "It proves that immature tissue can be transplanted in adult patients. Even if you put the tissue in an adult environment, it will be activated."

Fertility experts hailed the findings, published in the journal Human Reproduction, as a medical milestone.

Dr Geeta Nargund, medical director at Create Fertility, said: "This is a major breakthrough. It is one anecdotal case, but it's immensely exciting. It demonstrates a natural conception and a healthy baby in a woman who simply would not have had this option until now."

Professor Evelyn Telfer, a reproductive biologist at the University of Edinburgh, said the result would give other doctors confidence to treat their own patients with ovarian samples that were banked during childhood, something that is now routinely considered for certain types of chemotherapy. "This is really good news for all the other young women who have tissue stored," she said.

The patient, who was born in the Republic of Congo, suffered from severe sickle cell anaemia as a child and after emigrating to Belgium at the age of 11 was told she needed a bone marrow transplant. The procedure requires the patient's immune system to be disabled using chemotherapy, to prevent the donor marrow being rejected, but the treatment can permanently damage the ovaries.

Before chemotherapy, at the age of 13, doctors removed her right ovary. She had not started her periods, although she had started puberty.

Ten years later, the woman told doctors she wanted to have a baby and they grafted four fragments of the thawed ovarian tissue on to her remaining ovary.

Previously, the same grafting procedure had been shown to work when the ovarian tissue had been taken from adult patients, but until now the technique had never been shown to work using immature tissue.

At puberty, the ovaries contain hundreds of thousands of follicles, containing eggs that mature over many months. Scientists were not sure if this maturation process would continue normally after being paused for more than a decade while the tissue was frozen. The tissue was also being introduced into an adult female ovary, where hormone levels would be different from that in an adolescent girl.

The trial showed that the tissue appeared to "activate" completely normally and the woman began ovulating around five months after being given the graft.

She also conceived naturally without the need for IVF or any other fertility treatments, which Dr Demeestere said was a major advantage for someone with an extensive medical history.

The major remaining question is whether the treatment would work as effectively in younger patients who had not yet begun puberty. During childhood, a large proportion of the immature follicles in the ovaries are destroyed in what scientists believe may be an internal natural selection process designed to leave only the most viable mature eggs in place in the future. It is not clear whether scientists could replicate this pruning process outside of the body or whether it would be triggered automatically even when very immature ovarian tissue was grafted into a patient.

"Our work shows that tissue from pre-pubertal girls looks quite different to that of adults," said Professor Telfer. "Clearly we have to find out whether tissue from younger girls would work."

For those who have recovered from cancer as a child, doctors would have to weigh up the additional concern about re-introducing cancerous cells into the body when they performed any transplant, the authors said.

[Archy]

[Caliga]