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Could Allow Pregnancy Years After Ovary-Destroying Chemotherapy

For the first time, physician-scientists at the Center for Reproductive Medicine and Infertility (CRMI) of NewYork-Presbyterian Hospital/Weill Cornell Medical Center have taken a breast cancer patient's ovarian tissue that was frozen for six years, reimplanted it under her abdominal skin, and obtained an embryo from eggs collected from the tissue.

The unique achievement raises the possibility that women or girls who are about to undergo chemotherapy, radiation, or other ovary-damaging treatments can have their ovaries removed, frozen, and possibly used to restore fertility or reverse menopause at a later date. Some treatments used for cancer and other health conditions can destroy any chance of future pregnancy and create premature menopause in women.

The findings were fast-tracked for publication by The Lancet to be published online on March 9 and in print on March 13. The research study was led by Dr. Kutluk Oktay at NewYork-Presbyterian/Weill Cornell's Center for Reproductive Medicine and Infertility (CRMI).

This is the first case in medical history where an embryo has been obtained from frozen banked ovarian tissue after ovarian transplantation, said Dr. Kutluk H. Oktay, Associate Professor of Obstetrics and Gynecology at Weill Cornell Medical College and a specialist in Reproductive Endocrinology and Infertility at NewYork-Presbyterian/Weill Cornell's CRMI.

This research represents a potentially significant reproductive advancement in two respects: first, women can preserve their fertility by freezing their ovarian tissue, and second, pregnancy may be possible even after the tissue remains frozen for a long time, said Dr. Zev Rosenwaks, co-author of the Lancet study and Director of the CRMI.

The patient was diagnosed with breast cancer at age 30 and had an ovary removed and frozen. Five years later, after undergoing chemotherapy that cured her cancer, she contacted Dr. Oktay. After undergoing extensive counseling, 15 pieces of ovarian tissue were thawed and transplanted under the skin in her abdomen. After three months, the tissue began to produce hormones and eggs, and every month the eggs were collected to undergo in vitro fertilization.

In eight months, we collected about 20 eggs, and eight of those were good enough to be fertilized. We finally got an embryo that made it to the healthy-looking four-cell stage, said Dr. Oktay. The embryo was transferred to the patient's uterus although she didn't get pregnant. The chances of pregnancy with a single embryo are limited, probably less then 10%, so we're going to keep trying.

Dr. Oktay said the procedure could be of interest to many types of patients, both children and adults.

In this country, there are potentially several hundred thousand women and children who could benefit from this annually, he said. We have patients anywhere from 6-7 years old and up, said Dr. Oktay.

You could do it for pediatric cancer patients, adults, and women undergoing surgery for benign conditions in which you lose your ovaries, Dr. Oktay added. There are hematologic diseases in which you give patients drugs that have these side effects; it's not only for cancer.

Some types of bone disease require radiation treatments to the pelvis, which also damage fertility.

There's also the possibility that the procedure could be done electively. Can a woman preserve a piece of an ovary for future use against aging? This is always discussed, Dr. Oktay said. You might actually bank ovarian tissue potentially as long as you want and possibly preserve fertility. But this needs to be further studied.

The procedure is relatively noninvasive, said Dr. Oktay. The insertion under the skin is done with local anesthesia, as is the egg collection, he said. You can carry on a conversation with the patient while it's going on.

At this point, fewer than a dozen women worldwide have had ovarian tissue reimplanted in their body after fertility-damaging treatments, Dr. Oktay said.

We don't know how long these grafts will last; they tend not to last as long as the typical ovary inside the body, he said.

Dr. Oktay is an internationally recognized pioneer in the field of ovarian cryopreservation. In his first study published in the New England Journal of Medicine, he described the first pelvic ovarian transplantation with cryopreserved tissue. He published another study in 2001, reporting the first transplantation of ovarian tissue under the skin of the arm of two patients. In that case, the tissue produced eggs but no embryos.

Besides Dr. Oktay and Dr. Rosenwaks, additional co-authors include Dr. Erkan Buyuk, Dr. Lucinda Veeck, Nikica Zaninovic, Dr. Kangpu Xu, Dr. Takumi Takeuchi, and Dr. Michael Opsahl.