Establishing another "first" in reproductive medicine, an Alabama woman has given birth after undergoing an unprecedented transplant using ovarian tissue from another person. Stephanie Yarber, 25, gave birth to a 7-pound, 15-ounce baby birth named Anna on June 6. It's the first time anyone in the world has given birth following an ovarian tissue transplant from another person, doctors say.
The transplant, performed last year at a hospital in St. Louis, is described in the June 7 online edition of The New England Journal of Medicine.1
Breaking New Ground
While the technique is currently intended solely for those who are identical twins "to avoid any hint of a rejection problem," it could potentially be expanded in the future, explained Sherman Silber, MD, who performed the procedure, in an interview with Priority Healthcare.
"We anticipate that with mild immunosuppression regimes, the procedure could be a useful alternative to egg donation for many patients," said Silber, a urologist and Medical Director of the Infertility Center of St. Louis. "Since it is not a horrendous transplant operation any longer … immunosuppression is the only remaining issue to be studied."
Assisted Reproduction Failed
Yarber had been infertile for a decade. At the age of 14, she had become menopausal, experiencing what doctors describe as "secondary amenorrhea". By contrast, her twin sister, Melanie Morgan, was the mother of three naturally conceived children.
During Yarber's attempts to become pregnant, her sister donated eggs for in vitro fertilization, but after two cycles, the procedure was still not successful. After exhausting the ART option, Yarber decided to undergo the groundbreaking ovary transplant in April 2004. "The women were in excellent health, and the donor's ovarian function was considered to be normal on the basis of her reproductive history, peripheral hormone levels, ovarian ultrasonographic findings, and previous ovarian stimulation for IVF," wrote Silber and his colleagues in NEJM.
Using laparoscopy, Silber and his team removed one of Morgan's ovaries. Ovarian tissue was then transplanted to Yarber.
According to Silber and his group, Yarber was discharged from the hospital a day later and a follicle subsequently developed a little more than two months afterwards. Eighty days after the procedure, she resumed menstruating. About 6 months later, Yarber became pregnant, conceiving naturally. "She gave birth to a healthy-appearing girl at 38 weeks' gestation by vaginal delivery," Silber and his associates wrote.
Implications of Ovarian Tissue Transplantation
Since last year's first-ever transplant, Silber says he has performed the same procedure on two additional sets of identical twins. But such a transplant procedure between identical twins won't be performed much more in the future, he and his team pointed out, since other options exist for infertile women. Nonetheless, the procedure could have broad implications for women who are infertile, the physicians explained, such as those who want to preserve fertility while undergoing chemotherapy.
Silber's group pointed out that this procedure involved transplanting ovarian tissue, not the entire ovary, for practical reasons. For one thing, the tissue transplant is more minimally invasive and involves significantly less risk than transplanting an entire ovary. Additionally, extra tissue not transplanted can be frozen for later use if necessary, Silber wrote. There are other practical reasons. "To date, whole-ovary [freezing for a future transplant] has been successful only in rats and would be unlikely to be effective with the much larger human ovary," Silber's team wrote.
This isn't the first pregnancy after an ovarian tissue transplant. Last year, a Belgian woman reportedly gave birth after undergoing transplantation of her own ovarian tissue removed years earlier prior to chemotherapy.2 Surgeons in China have also reported a successful whole ovary transplant between sisters, though no pregnancy resulted.
"Ovary freezing with subsequent transplantation back to the same woman is currently the best way to expand reproductive lifespan," Silber said. "[For example,] many 25-year-old women will not try to get pregnant until they are 40. That is the reason for the current worldwide infertility epidemic. Ovary freezing and transplantation could resolve that dilemma for society."
Meanwhile, Silber and his colleagues are performing further research in this area. "The genetic studies we are doing with these twins will unlock the whole mystery to the genetic determination of reproductive lifespan and the age at which women become infertile," he said.
In a recent report on preserving fertility during cancer treatment,3 the American Society for Reproductive Medicine described ovarian tissue transplantation as "experimental", pointing out that it should currently only be performed in a research setting.
1. Silber SJ, Lenahan KM, Levine DJ et al. Ovarian transplantation between monozygotic twins discordant for premature ovarian failure. N Engl J Med 2005 Jun 7;[Epub ahead of print].
2. Donnez J, Dolmans MM, Demylle D et al. Live birth after orthotopic transplantation of cryopreserved ovarian tissue. Lancet 2004 Oct 16;364(9443):1405-10.
3. Ethics Committee of the ASRM. Fertility preservation and reproduction in cancer patients. Fertil Steril 2005 Jun;83(6):1622-8.
John Martin is a long-time health journalist and an editor for Priority Healthcare. His credits include overseeing health news coverage for the website of Fox Television's The Health Network, and articles for the New York Post and other consumer and trade publications.