World’s First Delivery From Ovarian Transplant

In a landmark medical development, a 38-year-old sterile women, who had an ovarian transplant last year, is set to give birth this week to the world’s first baby conceived after a full ovary transplant. Her ovaries failed at the age of 15.

This delicate and pioneering operation was done by Dr. Sherman Silber, the microsurgery pioneer of the Infertility Center at St Louis in Missouri, USA. Dr. Silber removed the ovary, which is the size of a walnut, from the donor who is the twin-sister of the patient, using keyhole surgery. He then implanted the ovary into the recipient and had to connect tiny blood vessels, just 0.33 mm in diameter, to establish blood flow to the organ.

Three months after the transplant the woman began to ovulate normally and her hormone levels were equal to those of her healthy twin after five months. The woman discovered she was pregnant about a year after the transplant.

Dr. Silber will discuss this pregnancy at a meeting of the American Society for Reproductive Medicine on Monday (Nov 10,2008), described the reconnection of the arteries and veins in the transplant as “extremely delicate”.

The transplant from an identical twin made it unlikely that the organ would be rejected. Transplants can be extended to close relatives but immuno-uppressive drugs are needed to prevent rejection of the organ.

After the ovary transplant, the previously sterile woman had periods for the first time in 22 years. In addition to the joy of becoming pregnant, the osteoporosis she had previously suffered showed signs of improvement as a result of restored hormone levels. The woman’s twin-sisiter, who already has two children, donated one of her ovaries to her sister. So the baby will, genetically, be the twin sister’s child.

The pioneering surgery will give hope not only to thousands of women who suffer an early menopause, but also to those undergoing chemotherapy or radiotherapy for cancer. They could now freeze an ovary before beginning the treatment.

The success also raises the possibility of women freezing ovarian tissue to postpone motherhood for social reasons, such as delaying marriage or not wishing to interrupt their careers.

Unlike IVF (In vitro fertilization), the conventional infertility treatment, an ovary transplant not only allows a woman to conceive “naturally” but also restores hormone levels in women who have suffered an early menopause.

The hormones produced in the ovaries — oestrogen, progesterone and testosterone — affect the female body in many ways, including prompting monthly periods and protecting the bones from osteoporosis.

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