CHICAGO — Sections of ovaries taken from two patients were implanted in their arms and continued to function there, raising hopes women can avoid the loss of fertility that often accompanies treatments for cancer and other diseases.
In both cases, the tissue produced clearly visible welt-sized bumps — mini ovaries, really — on the forearm, just below the elbow. But more important, the tissue appears to be functioning normally and has produced mature eggs and regulates the menstrual cycle. That offers hope that the women, both in their 30s, could become pregnant.
“It’s very promising,” said Dr. Kutluk Oktay, a Cornell University reproductive endocrinologist who performed the transplants at New York Methodist Hospital.
Oktay and colleagues describe the procedure in a report in Wednesday’s Journal of the American Medical Association.
Oktay said the procedure could potentially benefit the estimated 40,000 to 50,000 U.S. women diagnosed annually with cancer during reproductive years, who may require chemotherapy or radiation that can damage the ovaries. The tissue could be removed before treatment begins, then implanted in the arm after chemotherapy has finished and kept out of the way of radiation.
Thousands of others who take sterility-inducing drugs for ailments such as lupus and rheumatoid arthritis also could potentially benefit, Oktay said.
If pregnancy were attempted, it would be through in-vitro fertilization, and eggs would be retrieved in a simple procedure through a syringe, similar to drawing blood, he said.
Other attempts at preserving fertility include freezing patients’ unfertilized eggs, but only a few such cases have resulted in successful pregnancies. Whether tissue implants will prove more successful is unknown, said Dr. William Keye, director of reproductive endocrinology at William Beaumont Hospital in Royal Oak, Mich.
Still, Keye called the research “a pretty unique and exciting new development.”
“It’s certainly an important step forward in our understanding of this whole process,” Keye said.
A few hundred women nationwide already have had ovarian tissue removed and frozen before undergoing cancer treatment, hoping that a medical advance will allow them to use it someday to become pregnant, said Dr. Michael R. Soules, president of the American Society for Reproductive Medicine.
Soules said it’s uncertain how long implanted tissue will continue to function. He noted that while Oktay’s patients show functioning for more than a year so far, their tissue was never frozen, a procedure that could “traumatize” the tissue and make long-term success more doubtful.
Oktay and his colleagues used only part of the patients’ ovaries because it wasn’t necessary to take more, and it allows doctors to take only healthy tissue from damaged ovaries.
In a previous experiment, Oktay transplanted a patient’s ovarian tissue inside her pelvis, near the original ovary site, but he said the newer procedure is less invasive and the implanted tissue is much more accessible for monitoring. In addition, the forearm can be kept out of the way in cancer patients who may require repeated pelvic radiation.
Oktay noted that forearms also have been used successfully as an implant site for tissue from parathyroid glands located in the back of the neck. Those glands produce a hormone that helps control the level of calcium in the blood.
Rebecca Pryce, a 28-year-old television producer in Charleston, S.C., had ovarian tissue frozen after she was diagnosed with lymphoma, a lymph-tissue cancer, in January 2000.
Single, with no children, Pryce said learning she’d become sterile was almost harder to accept than the cancer diagnosis.
“That was the straw that broke the camel’s back,” she said. “That’s when I started to cry.”
Although she won’t be ready for an implant for several years, Pryce said she’s thrilled to learn of Oktay’s preliminary success.
“When you are in my shoes,” Pryce said, “any bit of positive news takes on a phenomenal amount of importance.”
Oktay said the patients in the JAMA report did not want to discuss their experiences.
One, a 35-year-old woman, had her ovaries removed before undergoing radiation for cervical cancer. After biopsies showed no cancer cells had spread to the ovaries, small strips of tissue were transplanted in November 1999 into her forearm, using local anesthesia.
That patient wanted children right away, so she was given fertility drugs to stimulate the tissue to produce several mature eggs. An attempt at in vitro fertilization failed, but the woman has continued to show normal ovarian function, Oktay said.
The second patient, a 37-year-old, had her ovaries removed because of benign cysts. Healthy ovarian tissue was transplanted to her forearm in April last year, and it also has functioned like a normal ovary.