Sept. 26, 2001 -- It sounds like science fiction — surgically moving a patient's organs around and getting them to work in different parts of the body.
That, in fact, is what doctors at Weill Medical College of Cornell University have now successfully done.
In today's issue of the Journal of the American Medical Association, Dr. KutlukOktay and colleagues report having successfully relocated pieces of ovary from the abdomens to the forearms of two women.
One patient had cervical cancer, for which she had to undergo radiation treatment that would have rendered her infertile if the ovaries had remained in place. The other patienthad to have her ovaries removed because of benign ovarian cysts, though parts of her organs were still healthy.
Healthy and Normal Eggs
By relocating their ovarian tissue, the doctors preserved the women's ability to produce healthy eggs which may later be removed from the arm and used for in vitro fertilization.
If the uterus is healthy, the fertilized embryos may be implanted in the patient's womb so she may carry the fetus. If the uterus is not sound, a woman could choose to have a surrogate carry the child.
Dr. Oktay's report showed the transplanted ovaries, now located just under the skin of the forearm (see photo above), functioned the same as they did in their original position; they secreted reproductive hormones, restored regular cycles of menstruation,and most important for fertility, actually produced mature eggs which appear healthy and normal.
The women said the transplants did not cause any pain or discomfort, but did remark they could "feel" the developing egg and surrounding tissue during the ovulation phase of their menstrual cycle. Oktay enthused: "we are very excited by how soon the transplantsbegan functioning, how well they worked, and how good the patients felt with their own hormones restored."
Dr. Beth Karlan, Director of Gynecologic Oncology at Cedars-Sinai Medical Center, comments, "Although no pregnancies have yet occurred, this report and the technique of ovarian autotransplantion clearly opens the door to future fertility for these women."
In addition to preserving future fertility, transplanted tissue has the added benefit of restoring hormone function and postponing menopause.
One Woman’s Hope
Until now, women with cancer or serious blood disorders have had to choose between lifesaving treatments and preserving their fertility. Losing the ability to bear children is often devastating, and for some women even more difficult to face than the cancer thatthreatens their lives.
Rebecca Pryce, a 26-year-old patient of Oktay's who was recently diagnosed with B cell lymphoma, says learning she would become sterile from the very treatments that might save her was unbearable. "On top of everything else I was going through at the time,finding out that I might not be able have children was the straw that broke the camel's back."
Because of the stage and progression of Pryce's lymphoma it was soon clear that she would require a bone marrow transplant to rid her body of the cancerous blood cells.
The radiation and chemotherapy necessary for killing the cells would permanently impair her ovaries. Given the serious nature of her disease, Pryce needed to start treatment as soonas possible and had no time to have her eggs extracted and stored, a process which requires weeks of hormone injections to stimulate the ovaries.
Pryce was shattered, and if not for the diligent research of family members in the medical profession she would not have had the opportunity of possibly building a family ofher own one day.
"I understand that the main concern of the oncologists and transplantdoctors is my immediate health and survival, but I was surprised that among all of theliterature I received there was no mention of possible ovary preservation. More women andparents of girls with cancer really need to be told about this procedure."
After consulting with Oktay, Pryce flew to New York where the doctor removed andfroze all of one ovary and two-thirds of the other.
"I didn't hesitate for a minute, it was sowonderful to have this option," Pryce says of the surgery. "And considering all theother horrible procedures I have been through, this one was a walk in the park."
Thousands May Benefit
Auto-transplantation of ovarian tissue could be done for women with cancer, blooddisorders, and even autoimmune diseases such as lupus that often require chemotherapytreatments that harm the ovaries. The procedure will also benefit women who must havetheir ovaries removed due to conditions such as benign cysts and endometriosis. A woman'sovarian tissue can be relocated as long as it is unaffected by disease.
As yet, it is not medically possible for one woman to donate her ovaries to anotherbecause, similar to other types of organ transplants, the donor and recipient must be aperfect blood and tissue match. And even if a close match were feasible, experts say theimmunosuppressive drugs which the recipient must take to prevent the transplant frombeing rejected cause numerous side effects that would seriously compromise fertility.
Oktay says experts estimate over 50,000 women of childbearing age are diagnosed withcancer every year. Add to this the many who suffer non-cancerous diseases which affecttheir ovaries and the number of women who may benefit from ovarian transplantation jumpsto between 70,000 and 80,000. Considering all the young girls whose fertility could be preserved pushesthe total even higher.
Because the technique is still considered experimental, health insurance companiescurrently will not pay for any part of the removal, freezing, or implantation of ovariantissue. Pryce estimates her total out-of pocket expenses, including travel to NewYork, ran close to $10,000. The hospital bills were about $4,000 to $5,000, and the freezinganother flat fee of about $1,000.
Insurance carriers may possibly begin covering the procedure once it is proveneffective in a larger group of women, and the eggs produced are shown to produce viableembryos.