Women who need chemotherapy have to contend with one side effect that’s lesser-known than nausea and hair loss: the potential that the harsh treatment will damage their ovaries, making them permanently infertile.
If a woman wants to preserve her fertility and can’t put off chemotherapy long enough to get her eggs frozen (a process that is by no means a sure thing anyway), there’s one cutting-edge, still unproven procedure that could be an option: having some of her ovarian tissue removed and frozen.
That tissue can then be transplanted back into her body later, in hopes it will resume normal function and enable her to get pregnant. The tissue transplants include primordial follicles that gradually mature and produce eggs, one of which is released for potential fertilization each month.
The procedure has had some success — several babies have been born to women who’ve had ovarian tissue frozen and reimplanted, but the American Society for Reproductive Medicine still considers it experimental.
For girls who haven’t started menstruating, freezing ovarian tissue is their only option to preserve their fertility — they don’t yet have any mature eggs to harvest, so egg freezing is simply not possible. But it hasn’t been clear whether their immature ovarian tissue would be able to produce healthy eggs when thawed and transplanted many years later.
Now, for the first time ever, there’s evidence it works. The first baby was born from a woman who had ovarian tissue frozen before she started menstruating, scientists announced in a June 9 case report published in Human Reproduction.
The birth of a single baby gives us no information about the efficacy of the procedure overall or how well it will work in others. But it does suggest an important line of research for girls who historically have had to say goodbye to the possibility of having biological children long before they would even be considering it. Here’s the story behind this exciting scientific first.
The unlikely baby
The woman described in the case study grew up with sickle-cell anemia so severe that her doctors decided she would need a bone marrow transplant. To prevent her body from rejecting the transplant, she would have to undergo chemotherapy, which disables the immune system.
At the age of just 13, she faced the prospect of losing her ovarian function — a common side effect of chemo — which would render her unable to have children in the future.
Rather than accept that possibility, her doctors decided to try something that had no guarantee. They removed her right ovary and froze fragments of the ovarian tissue, putting them aside for the uncertain future.
More than a decade later, when the woman was 25, she wanted to get pregnant. The ovary that had not been removed had failed long ago, and she couldn’t menstruate naturally. So it was time to see whether the longshot procedure she’d had at 13 would pay off.
A team of doctors led by Isabelle Demeestere, a gynecologist and research associate at Erasme Hospital, took some of her preserved ovarian tissue and grafted it back into her body.
And then they waited.
Four months later, her hormone levels looked like a normal, fertile woman’s. A month after that, she started menstruating without taking hormone therapy, which meant eggs were maturing and being released for potential fertilization.
Finally, in November 2014, at the age of 27, the woman gave birth to a healthy boy conceived naturally. Her ovarian tissue is still functioning normally, and her doctors say it’s entirely possible she could get pregnant again if she wanted to.
“This is an important breakthrough in the field because children are the patients who are most likely to benefit from the procedure in the future. When they are diagnosed with diseases that require treatment that can destroy ovarian function, freezing ovarian tissue is the only available option for preserving their fertility,” Dr. Demeestere said in a statement.
Not for everyone
With more American women delaying having kids until they’re older, ovarian tissue cryopreservation may seem like a way to do that without resorting to in vitro fertilization.
The medical establishment discourages that thought, however. In May 2014 the practice committee of the American Society for Reproductive Medicine issued an opinion explicitly saying ovarian tissue should not be frozen for healthy women who want to delay having kids.
Dr. Kutluk Oktay, who first reported successfully transplanting frozen ovarian tissue to restore fertility, explained that doing such an invasive procedure in a healthy woman who may be able to have kids without the procedure is not justifiable.
“You may do more harm than benefit,” he told Business Insider.
The procedure could actually reduce the amount of time a woman is fertile, he explained, because it might remove more potential eggs than would be replaced when the tissue is transplanted back into the woman’s body.
Even though this technology might not herald a new way to preserve fertility for all women, it’s truly groundbreaking for women who previously wouldn’t have been able to have kids because of chemotherapy.
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