Doctors transplant ovary to woman’s arm to preserve fertility

A new study finds surgery to transplant an ovary to the upper arm is feasible and preserves hormonal function in women undergoing treatment for cervical cancer. The report details the technical procedure and outcome of only the second successful human ovarian autotransplantation in the world. The study will be published in the December 15, 2004 issue of CANCER, a peer-reviewed journal of the American Cancer Society. A free abstract of this study will be available via the CANCER News Room upon online publication.

While treatment for cervical cancer, including systemic chemotherapy and regional administration of ionizing radiation, improves survival and cure rates, it can also cause permanent ovarian failure. Since cervical cancer is diagnosed during reproductive years, ovarian failure can be a severe blow to a patient’s quality of life. While protecting a patient’s fertility has often been studied, there have been no effective options.

Hormonal regulators, such as gonadotropin-releasing hormone, have demonstrated ovarian protection in rats but conflicting data in nonhuman primates. Cryopreservation of embryos has been successful, but there have been no reported successful cryopreservation and transplantation of oocytes or primordial follicles, which are necessary for future fertility. Attempts at ovarian tissue autograft or xenograft without blood vessel anastamoses in animal models and human cases have been promising but hampered by large follicle loss due to ischemia. However, animal models with anastamoses have demonstrated success, but there has been only one prior successful human autotransplant.

In this second successful human trial, C. Hilders, M.D., Ph.D., and a gynecologic surgical team of the Leiden University Hospital, The Netherlands developed a new method of ovarian autotransplantation to preserve ovarian function in a woman treated for cervical cancer. This method does not require developing a donor site with an implant over several months and utilizes a donor site that is easily accessible to noninvasive monitoring and has suitable vasculature.

Autotransplantation of a healthy ovary into the upper arm using brachial vessels to establish blood supply resulted in a functional ovary. Blood flow to and from the ovary was adequate to maintain cyclical follicular growth as verified by ultrasound and clinical examination. Moreover, the surgery did not result in additional operating time.

The authors conclude, “it seems likely that ovarian autotransplantation will be a realistic goal to achieve for women facing cancer, treated by high dose pelvic radiation, to preserve reproductive and hormonal function, thereby substantially improving the quality of life post-treatment.”