Frozen ovary in childhood allowed to give birth to a child
Doctors of the Erasmus Clinic at the University of Brussels, working under the guidance of Dr. Isabelle Demeestere, for the first time achieved the birth of a healthy child in a patient whose reproductive function was restored by transplantation of her own ovarian tissue, removed and cryopreserved in childhood.
It is already difficult to surprise specialists with a successful pregnancy after transplantation of ovarian tissue removed from an adult woman and cryopreserved for subsequent use. However, until now there has not been a single publication devoted to such a procedure performed with ovarian tissue isolated from girls who have not reached puberty. The ability of such immature ovarian tissue to mature and form mature eggs is not fully clear today.
The first swallow was a young resident of Belgium, born in the Republic of the Congo. At the age of 5, she was diagnosed with sickle cell anemia. After emigrating to Belgium at the age of 11, the attending physician decided that the severity of her condition required a bone marrow transplant, the donor of which was her brother. This procedure requires so–called conditioning – the destruction of the patient's own immune system - to prevent rejection of the donor bone marrow. This is usually done with the help of chemo or radiotherapy, which irreversibly disrupts the functioning of the ovaries.
Therefore, before starting conditioning, doctors removed the patient's right ovary and divided it into fragments, which were subsequently cryopreserved. At that time, the girl was 13 years and 11 months old, she had not yet had menstruation, but there were signs of puberty, manifested by the beginning of breast growth at the age of 10.
Bone marrow transplantation was successful, however, the patient developed a graft-versus-host reaction (GVHD), which necessitated taking immunosuppressive drugs for 18 months after the procedure. At the age of 15, the girl's preserved left ovary stopped functioning and doctors prescribed hormone replacement therapy to stimulate menstruation.
After 10 years, the patient sought advice and expressed a desire to get pregnant. To restore her fertility, doctors stopped hormone replacement therapy and defrosted part of the fragments of her right ovary, 4 of which were transplanted into the tissue of the preserved left ovary, and the remaining 11 – in other places: 6 – in the right part of the peritoneum (peritoneal bursa), 5 – under the skin.
The transplanted tissue quickly began to respond to hormones produced by the woman's body and successfully form full-fledged follicles containing maturing eggs. Five months after the operation, the patient began to have natural regular menstruation. Due to the infertility of her partner, she asked for help in carrying out artificial insemination, but later refused due to the breakup of the relationship. Two years later, at the age of 27, the woman became pregnant naturally and in November 2014 gave birth to a healthy boy weighing 3,140 g .
The transplanted tissue continues to function normally in the patient's body and doctors believe that, if desired, she can not stop at the birth of one child. In case of graft insufficiency, she can undergo the procedure of transplanting the remaining fragments of the ovary.
However, despite the success, doctors note that the procedure requires further confirmation of its effectiveness in relation to patients who, at the time of removal of ovarian tissue, had not reached puberty, the first signs of which were already observed in the heroine of this study.
Article by Isabelle Demeestere et al. Live birth after autograft of ovarian tissue cryopreserved during childhood is published in the journal Human Reproduction.
Evgeniya Ryabtseva
Portal "Eternal youth" http://vechnayamolodost.ru11.06.2015