Physician Performs First Whole Ovary Transplant In U.S.; Procedure Could Restore Fertility In Women With Cancer

Sherman Silber, director of the Infertility Center of St. Louis at St. Luke's Hospital, and colleagues last month performed the first complete ovary transplant in the U.S. on twin sisters and last week performed the procedure again on sisters who are not twins, the AP/Kansas City Star reports. According to the AP/Star, the procedure could restore hormone function in women experiencing early menopause because of cancer treatments or other causes (Taylor, AP/Kansas City Star, 2/13). More than 80% of fertile women who undergo chemotherapy for cancer treatment become infertile and experience premature menopause (Kaiser Daily Women's Health Policy Report, 6/8/05). It also is possible that the procedure could allow a woman diagnosed with cancer to freeze an ovary and have it returned to restore fertility after chemotherapy or radiation, the AP/Star reports. Physicians at Zhejiang Medical Science University in China earlier this decade reported a successful whole ovary transplant, but there has not been any published medical literature on the case (AP/Kansas City Star, 2/13). Silber and colleagues in April 2004 successfully removed an ovary from Melanie Morgan and transplanted tissue from 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. The physicians microsurgically sutured the outer tissue of the donated ovary -- which contains egg-producing follicles -- to each of Yarber's nonfunctioning ovaries. Yarber had a menstrual period 80 days after the transplant, and she gave birth to a healthy infant in June 2005 (Kaiser Daily Women's Health Policy Report, 6/8/05). Silber since has performed similar partial ovary transplant procedures on six other sets of twins, and he said that all of the women are ovulating and menstruating normally and that two of the women have delivered infants, the St. Louis Post-Dispatch reports. Silber said the women who have received partial transplants likely will have only two to five years of ovarian function but he added that he hopes the whole ovary transplants will function for decades because those organs have their own blood supply (Hesman Saey, St. Louis Post-Dispatch, 2/12).

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Some physicians are questioning whether the benefits of the procedure -- which include restored fertility and natural hormone production, which helps prevent osteoporosis and heart disease -- outweigh the procedure's risks, which include the side effects of antirejection drugs, the Post-Dispatch reports. Richard Gimpelson, former president of the American Association of Gynecologic Laparoscopists, said that legal, religious and ethical issues that do not apply to other organ transplants might become an issue for ovary transplants. "[O]ther organs are donated to save someone's life," Gimpelson said, adding, "The ovaries are [transplanted] to make someone's life complete. It's a little bit different" (St. Louis Post-Dispatch, 2/12). Pasquale Patrizio, who directs the fertility center at Yale University and is working on freezing and thawing ovaries to help women with cancer preserve their fertility, said that Silber's work will help determine "if the entire organ can be successfully retransplanted" (AP/Kansas City Star, 2/13).














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