A 28 year old Israeli woman who became infertile after treatment for non-Hodgkin’s lymphoma has given birth after the successful transplantation of cryopreserved ovarian tissue that was removed from her body before chemotherapy.
Sagit Hechler, aged 28, who already had a boy, gave birth on 27 June to a girl at Sheba Medical Centre near Tel Aviv. The event was reported by the team, headed by Dror Meirow, Jacob Levron, and Jehoshua Dor of Sheba, as correspondence to the online edition of the New England Journal of Medicine on 27 June (www.nejm.org, doi: 10.1056/NEJMc055237). It will appear in the print edition on 21 July.
This seems to be the third case of a woman giving birth after receiving transplanted ovarian tissue. On 7 June in the United States a previously infertile woman, who had received an ovary transplant from her identical twin sister, gave birth to a baby girl after treatment at St Luke’s Hospital in St Louis, Missouri (New England Journal of Medicine 2005;353:58-63).
Last year a Belgian woman received her own ovarian tissue back seven years after treatment for cancer and gave birth to a baby, although it wasn’t certain whether the ovum that resulted in the birth came from the reimplanted tissue or from ovarian tissue that had remained in her body (Lancet 2004;364:2091-2). And more than a year ago surgeons in China reported a successful whole ovary transplant between sisters, but the woman has not yet become pregnant.
As few infertile women have an identical twin, the Israeli method is considered to have the best potential. The doctors at Sheba said the experimental technique should initially be used only in cancer patients who want children after their recovery and who understand the risks. Eventually it might be used for women who want to put off pregnancy until they are older and have babies using ovarian tissue cryopreserved when they were younger.
Before Hechler underwent chemotherapy, the Sheba doctors removed ovarian tissue and froze it for two years, during which time she had no menstrual periods and was regarded as infertile. Strips of the tissue were defrosted and attached to her left ovary, and fragments were injected into the right one.
Her menstrual periods returned nine months later. A single egg was removed from the left ovary, and in vitro fertilisation by sperm from her husband resulted in a healthy embryo, which was implanted.
The Sheba team said that although they could not rule out the possibility that the egg was derived from the native ovary, they thought the possibility highly unlikely, because tests had consistently shown she was infertile before that and because of the timing of restoration of ovarian function after transplantation.
The Israelis wrote that transplantation of ovarian tissue is "associated with a theoretical risk of grafting malignant cells." But they tested the tissue they harvested from her ovary very carefully, and it showed no evidence that cancer cells had spread to it from her lymphatic system.