It sounds a little like science fiction, but researchers in the Netherlands report they were able to preserve fertility in a 29-year-old cervical cancer patient by removing her ovary prior to treatment and placing it inside her upper arm.
Investigators say the transplantation technique is a promising option for preventing infertility among women in their childbearing years undergoing pelvic radiation for cancer.
The transplanted ovary has continued to produce hormones in its new location in the two years since the surgery was performed. But the patient has not yet attempted to have a child because of a return of her cancer last year.
If pregnancy were attempted, it would be through in vitro fertilization. Eggs would be retrieved from the transplanted ovary in the arm.
"The upper arm is a very suitable place for [egg] retrieval because it is easy to get to," lead researcher Carina G. Hilders, MD, PhD, tells WebMD.
Infertility Common After Treatment
As many as 50,000 women in their childbearing years are diagnosed with cancer each year in the U.S. With more and more of them surviving, preserving fertility following cancer treatment has become a major area of research. Chemotherapy, radiation, and surgery often bring on premature menopause, and the options for preserving fertility are few.
In September, researchers in Belgium reported the first live birth from frozen ovarian tissue. The tissue had been removed from the woman and banked seven years earlier, before she underwent chemotherapy for Hodgkin's disease.
Ovarian transplantation is not appropriate for women treated with chemotherapy, but it may be a better option than the ovarian freezing and thawing technique for those who have pelvic radiation, Hilders says. That is because damage to egg-containing follicles in ovaries is minimal with transplantation and may be extensive with freezing and thawing.
'Promising But Preliminary'
The researchers conclude that "it seems very likely that ovarian autotransplantation will be a realistic goal to achieve for women with cancer who receive high-dose pelvic radiotherapy."
The case represents the second successful ovarian autotransplantation. The first was reported in 1987, but it was a more involved procedure than the one performed by Hilders and her Leiden University Medical Center colleagues. Cornell University researchers have also transplanted ovarian tissue into the arms of several cancer patients.
Kutluk Oktay, MD, who led the Cornell research, says his approach involved freezing ovarian strips and implanting them back into cancer patients once they had completed treatment. For this reason, it can be used in chemotherapy patients, and it is a much simpler surgery than transplanting the entire ovary.
"Relocating the ovary is a very complicated procedure that is done by a transplant surgeon," he tells WebMD. "It is true that if it works you may preserve more (ovarian function), but you could also lose the whole ovary if it fails."
American Cancer Society gynecologic disease expert Debbie Saslow, PhD, says the research sounds promising but is still very preliminary.
"This shows that in principle this is an approach that could preserve fertility, but this study included just one patient," she says. "I would certainly want to see this duplicated in other patients, but any option that is safe and could be useful is worth further research. Right now there just aren't a lot of options out there."
SOURCES: Hilders, C. Cancer, Dec. 15, 2004, online edition. Carina G. Hilders, MD, PhD, department of gynecology, Leiden University Medical Center, Netherlands. Debbie Saslow, PhD, director of breast and gynecological cancer, American Cancer Society. Kutluk Oktay, MD, associate professor of reproductive medicine and obstetrics and gynecology, Center for Reproductive Medicine and Infertility, New York Presbyterian/Weill Cornell, New York.
By Salynn Boyles
Reviewed by Brunilda Nazario, MD
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