Fertility Preservation with Ovary Transplantation

Several days ago, the first patient in the United States delivered a healthy baby from a transplanted ovary which had been frozen thirteen years ago, before she underwent otherwise sterilizing cancer treatment as a 19 year old girl. Dr. Silber’s paper published in Fertility and Sterility, provides otherwise rare information for guiding fertility preservation practices, and counseling patients about the likelihood of success of ovary transplantation. This is the largest series of ovarian transplants to date, with the largest number of pregnancies and live births, and the longest number of follow-up years to evaluate the efficacy of ovary transplantation, fresh or frozen, and the expected duration of function of the transplanted ovary.

After fresh or frozen ovary transplantation, these patients have essentially a completely normal pregnancy rate and delivery rate as would be expected in any normal group of women who had never had cancer or who had never required ovary transplantation to cure their premature menopause.

Ovarian tissue frozen to preserve fertility should be able to completely restore the fertility that the young woman would have had if she had never undergone otherwise sterilizing radiation and chemotherapy.

One in every 250 young women today are cancer survivors, but their cancer treatment usually has rendered them sterile. With the approach of ovarian tissue freezing and transplantation, their fertility can now be preserved, and rather inexpensively. Interestingly, most of these cancer survivors whose frozen ovarian tissue is stored with us, tell us that they felt "fortunate" that they were diagnosed with cancer. While this is an odd thing to say, they point out that their girlfriends in their 30's are all worried about their biological clock, but these cancer survivors do not have to worry about that, because their frozen ovarian tissue is that of a teenager or woman in her 20's, the time in their lives when their ovary tissue frozen.

One, therefore, has to consider whether this could be also be offered to young women who need to put off childbearing aspirations until they are in their late 30's or 40's, as so many women in our modern society must do. This presents an option for them to preserve their fertility, not against the consequences of cancer therapy, but against the slowly ticking away of their biological clocks.

Infertility is a huge and growing global epidemic, and the reason for this epidemic is the putting off of childbearing by so many modern women. In previous generations, the norm was to get married in our early 20's and have all our children before age 30. At one time, you were considered to be really old at 65 if lucky enough to live that long. Now we all plan to be very healthy and active into our 80's and, therefore, childbearing is put off until one’s late 30's or early 40's or even later. But a woman’s eggs still age and by the late 30’s, 50 percent of women are infertile. If ovary or egg freezing were offered to these women while they were still young, we could completely overcome this infertility epidemic.

During a campaign breakfast a few years ago, Dr. Silber had the wonderful opportunity to meet Hillary Clinton. In just a few minutes she found out about Dr. Silber’s work in infertility, running a large IVF program, and asked why there was so much more infertility nowadays. Dr. Silber explained about the biological clock and she asked what he was going to do to solve this problem. Dr. Silber told her about ovary and egg freezing at the Infertility Center of St. Louis, currently being used only for cancer patients, because of potential ethical questions about using this method “just” to prolong the fertility of women who do not have cancer. Her very direct and immediate answer to that was: "I THINK THIS IS A NO BRAINER. YOU SHOULD OFFER IT TO ANYONE, WITH OR WITHOUT CANCER." So the ultimate implication of these findings is the availability to prolong the reproductive lifespan not only of cancer patients, but of any young woman who needs to postpone childbearing.

This method is about to be applied also to freezing ovarian tissue for younger pediatric-age patients who are pre-pubertal, which should work as well as for post-pubertal young women. The plan is to do the same with the testes of pre-pubertal boys who obviously cannot give us a sperm sample to freeze.