Surgeons in China do first whole ovary transplant
By Pooja Vig
SINGAPORE, Apr 11 (Reuters Health) - Doctors in China have performed the world's first whole ovary transplant at the Zhejiang University Medical School in eastern China.
A 34-year-old woman, Tang Fangfang, has received an ovary along with its fallopian tube from her younger sister. "The transplanted ovary is performing normally and our tests show that it is producing hormones," Dr. Zheng Wei, who performed the procedure, told Reuters Health.
Tang's ovaries and fallopian tubes were removed after she developed ovarian cancer 2 years ago, which resulted in complications associated with early menopause. "When Tang came to see me, she had tried hormone replacement therapy (HRT) for over a year but she suffered stomach discomfort and other symptoms," Zheng said.
"It was a difficult procedure because her (ovarian) artery and vein were delicate as a result of her medical history," he added. Fortunately, tissue rejection was thought to be of relatively low risk. "This is a very unusual case as her sister is a near-perfect tissue match."
Theoretically, Tang can conceive naturally in the future. However, because the eggs will be produced by the transplanted ovary, any child will genetically be her sister's, not hers, Zheng pointed out.
Tang could have opted for in vitro fertilisation using a donated egg and her partner's sperm. "In her case, it was a combination of wanting a child, restoring her hormones, plus she was fortunate to find a close genetic match," Zheng explained.
Zheng's team has received many requests to perform similar transplants. The team plans to establish an ovary bank at its hospital but harvesting ovaries is expected to pose major problems.
"I advise patients to first consider hormone replacement therapy to restore hormones or in vitro fertilisation to try for a child as this procedure will not work for everybody," Zheng said.
Similar caution about ovary transplantation is echoed by others in the field, including Dr. Christopher Chen, a fertility specialist in Singapore. "HRT can be used to replenish female hormones and transplanting an ovary simply to restore hormones is perhaps not justified in terms of discomfort, the risk of graft rejection and the danger of the surgery itself."
Currently, women undergoing chemotherapy--which can damage eggs-might be able to freeze their own ovaries for self-transplantation until after treatment is completed. However, the freeze-thaw process kills the majority of growing eggs and a significant supply of stored eggs. To date, experimental transplants of frozen and thawed ovarian grafts have resulted in just one ovulation in one woman.
While the idea of using a transplanted ovary to restore fertility--or even simply for hormone production--is promising for some women, there are controversial potential applications with ethical implications.
For example, Zheng pointed out, once the technique is refined women could choose to preserve an ovary while young in order to re-implant it much later in life and have children well beyond normal childbearing age. Stored ovarian tissue could also be used to delay the onset of menopause.
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