Ovarian tissue storage and later transplant shows promise for women infertile from cancer therapy
NB: Please note that if you are outside North America, the embargo for LANCET press material is 0001 hours UK Time Tuesday 9 March 2004
US researchers report promising findings of a technique which could potentially help women to regain fertility after early menopause due to cancer therapy. Results of the technique on a 30-year-old woman are reported in a fast-track study to be published online ahead of publication in the March 13 print issue of THE LANCET.
Cancer treatments such as chemotherapy, radiotherapy, and radical surgery can induce premature menopause and infertility in hundreds of thousands of women of reproductive age every year. One of the ways to possibly preserve fertility before these treatments is to freeze (cryopreserve) ovarian tissue for later transplantation.
Kutluk Oktay and colleagues from the Center for Reproductive Medicine and Infertility (CRMI) of NewYork-Presbyterian Hospital/Weill Cornell Medical Center, USA, cryopreserved ovarian tissue from a 30-year-old woman with breast cancer before chemotherapy-induced menopause. This tissue was transplanted beneath the skin of her abdomen 6 years later. The patient's ovarian function returned after three months, and in-vitro fertilisation resulted in the development of a four-cell embryo which was implanted into the woman, although she did not become pregnant.
Dr Oktay comments: "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." (quote by e-mail, does not appear in published paper)
In an accompanying Commentary, Johan Smitz from the Centre For Reproductive Medicine, University Hospital of the Vrije Universiteit Brussels, Belgium, cautions that cryopreservation and transplantation techniques for certain cancer cases are not without risk: "In light of the current uncertainty about the effectiveness and safety of ovarian cryostorage and grafting, the whole procedure should still be presented as experimental to patients. Only a small part of the ovarian graft can be screened with sensitive techniques for the detection of hosted cancer cells. For some cancers: those that colonise the ovary or that can metastasize into ovary, it will be always difficult to completely exclude the presence of such cells in the graft. To provide an evidence-based approach in future practice, a multicentre trial could be proposed in which girls or young women at intermediate risk of sterility would be randomised between storage of gonadal tissue or non-intervention. Such a prospective study would show which of the two options gives the best chances for obtaining a normal child. Whole-ovary freezing that allows vascular reanastomosis and more in-vitro work, including embryonic stem-cell culture, could provide alternative solutions for patients".
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