MARCH 15, 2007


Whole ovary transplant reverses early menopause

Two successful cases in US raise hopes

"When you walk on the edge of a cliff like the Grand Canyon, you're not supposed to look down because you get dizzy and it kind of scares you. When I looked away from the microscope to see what we were really suturing, I got really scared because it just looks like it's going to tear apart," said veteran micro-surgeon Dr Sherman Silber of his harrowing yet successful ovary transplantation on Joy Lagos, a woman who became menopausal in her late 20s after a battle with non-Hodgkins lymphoma.

Twenty-one days later the patient is recovering well, and has even started to feel the effects of her new ovary. "I feel a little more hormonal than I have for a long time — a little more emotional. I get affected by things like sad movies now," Mrs Lagos, who turned 30 while recuperating in the hospital, says with a chuckle.

Dr Silber performed the operation on February 5 at St Luke's Hospital near St Louis. Mrs Lagos was only the second North American to receive a whole ovary transplant and the first non-twin. The donor was her sister, Maeapple Chaney.

The operation wasn't Dr Silber's first brush with ovary transplantion. About one month earlier, the infertility treatment pioneer performed a similar operation on twins (who haven't gone public with their story) which was also successful. But it'll take about three months before we know if either woman's fertility has been restored.

He's previously performed seven surgeries where he implanted strips of ovarian tissue, rather than whole ovaries. All of these patients received donor tissue from twin sisters, and all of them eventually resumed normal ovulation and menstruation. One recipient, Stephanie Yarber, went public with the news that she'd had two children since receiving the tissue transplant in 2004.

The problem with transplanting only strips of ovarian tissue, explains Dr Silber, is staying power. The procedure is likely to only buy a few years of ovarian function, while a whole ovary transplant might last much longer. "If they want to have longterm natural ovary function for decades instead of just two or three years to have a baby — [whole ovary transplantation] is the way you have to do it," says the doctor.

Back in 2002 the Chinese media reported a successful whole ovary transplant at the Zhejiang Medical Science University. The surgeon, Dr Zheng Wei, told China Daily that his 34-year-old patient, Tang Fangfang received the ovary from her sister. Like Joy and Maeapple, Ms Fangfang and her sister were unusually close tissue matches for non-twins, so no anti-rejection drugs were needed.

Joy and her husband Rodrigo were intrigued by the case. The scientifically literate Mrs Lagos (who completed pre-med studies prior to getting stricken by cancer) was frustrated by the lack of published evidence on the case. But everything changed when her husband caught a news report of Dr Silber's work on television. They were convinced that she was a perfect candidate. While she didn't have a twin, she had a sister who'd already donated bone marrow without any rejection issues.

"I was fully ready to argue my case," Mrs Lagos insisted. Fortunately the US Air Force veteran — she was a nuclear weapons technician during the first Gulf War before she went back to school — never even had to put up her dukes. She explained her situation to one of Dr Silber's assistants and the surgeon got back to her quite quickly. After testing again to be absolutely certain of the genetic match between the sisters, it was smooth sailing.

"We knew we had an ace up our sleeves because of her sister being a genetic match," recalls Mr Lagos. When they first met with Dr Silber in December, the plan was to go forward with the tissue strip procedure. But the surgeon called back soon after to say that based on his research, a full ovarian transplant might be appropriate.

The risks for Mrs Lagos, he explained, were just the usual ones associated with any surgery — clots, infection, etc — but her 31-year-old sister faces the possibility of entering early menopause as a result of donating an ovary.

Sadly, it seems unlikely that this procedure will become common practice. First, ovary donors would be hard to come by. And Dr Silber feels that we don't yet know enough about the effects of anti-rejection drugs on a recipient and potential fetuses, should she become pregnant. "If they're not a close match, we're not ready to tackle that yet," Dr Silber told the Associated Press. And then there's the difficulty of the procedure itself, which involves attaching the fragile, thread-like artery of the donor ovary to the recipient.

But Joy Lagos hopes to see this treatment one day become an option for all prematurely menopausal patients. "I would tell anyone who could to just go for it. If someone is interested in getting more back than just being able to have children and if it's important for them to feel the effects of their hormones, then definitely this is worth it," she says.

"Your oncologist is primarily concerned with saving your life — and that's understandable. I was physically fine after beating cancer — except I didn't feel like a 27-year old woman. It just felt like something was missing," she explains.



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