Live birth reported after ovarian tissue transplant
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《英国医生杂志》
The first live birth to a woman after an ovarian tissue transplantation was reported last week.
Ouarda Touirat, a 32 year old Belgian, gave birth to a 3.7 kg healthy baby girl at Cliniques Universitaires Saint-Luc, Brussels, Belgium (report published early online at www.thelancet.com (24 September)). In 1997, at the age of 25, she was given a diagnosis of advanced (stage IV) Hodgkin抯 lymphoma. Before her course of chemotherapy was started, five biopsy samples (12-15 mm long and 5 mm wide) were taken laparoscopically from her left ovarian cortex and cryopreserved in liquid nitrogen at a temperature of almost - 200oC. The research group managing her care did not consider that removal of the whole ovary was an option as they could not completely exclude recovery of ovarian function after chemotherapy. Her right ovary remained intact.
After almost a year of treatment for cancer, which included radiotherapy, her periods ceased, and hormone concentrations indicated she had premature ovarian failure. She then had more than two years of hormone replacement therapy, which was stopped in January 2001 because she wanted to get pregnant. An evaluation by oncologists at the time showed that she was free of disease.
Ms Touirat began the ovarian tissue reimplantation procedure in February 2003. A large strip and 35 small cubes of the ovarian tissue were transplanted laparoscopically into a small groove that had been created in the peritoneum near the fimbria on the right side. No suture was used. Five months later her menstrual cycle was restored.
In January 2004, nearly a year after reimplantation of the tissue, Ms Touirat became pregnant, conceiving naturally without the aid of in vitro fertilisation or ovarian stimulation. The research group showed that the fetus arose from an egg released by the cryopreserved, transplanted tissue and not from the right ovary or the remnants of the left ovary.
The technique of cryopreservation of ovarian tissue before cancer treatment means that fertility can be preserved without delaying the start of chemotherapy. Professor Jacques Donnez, of the Catholic University of Louvain in Brussels, who led the research group, said: "Ovarian tissue cryopreservation should be an option offered to all young women diagnosed with cancer."
However, potential risks include the possibility that tissue taken for cryopreservation may harbour seeds of malignant cells overlooked by current screening methods and so could induce a recurrence of the disease after reimplantation. This problem has been seen in animal models. Ethical questions concern the possibility of women delaying menopause and extending their reproductive lives.(London Debashis Singh)
Ouarda Touirat, a 32 year old Belgian, gave birth to a 3.7 kg healthy baby girl at Cliniques Universitaires Saint-Luc, Brussels, Belgium (report published early online at www.thelancet.com (24 September)). In 1997, at the age of 25, she was given a diagnosis of advanced (stage IV) Hodgkin抯 lymphoma. Before her course of chemotherapy was started, five biopsy samples (12-15 mm long and 5 mm wide) were taken laparoscopically from her left ovarian cortex and cryopreserved in liquid nitrogen at a temperature of almost - 200oC. The research group managing her care did not consider that removal of the whole ovary was an option as they could not completely exclude recovery of ovarian function after chemotherapy. Her right ovary remained intact.
After almost a year of treatment for cancer, which included radiotherapy, her periods ceased, and hormone concentrations indicated she had premature ovarian failure. She then had more than two years of hormone replacement therapy, which was stopped in January 2001 because she wanted to get pregnant. An evaluation by oncologists at the time showed that she was free of disease.
Ms Touirat began the ovarian tissue reimplantation procedure in February 2003. A large strip and 35 small cubes of the ovarian tissue were transplanted laparoscopically into a small groove that had been created in the peritoneum near the fimbria on the right side. No suture was used. Five months later her menstrual cycle was restored.
In January 2004, nearly a year after reimplantation of the tissue, Ms Touirat became pregnant, conceiving naturally without the aid of in vitro fertilisation or ovarian stimulation. The research group showed that the fetus arose from an egg released by the cryopreserved, transplanted tissue and not from the right ovary or the remnants of the left ovary.
The technique of cryopreservation of ovarian tissue before cancer treatment means that fertility can be preserved without delaying the start of chemotherapy. Professor Jacques Donnez, of the Catholic University of Louvain in Brussels, who led the research group, said: "Ovarian tissue cryopreservation should be an option offered to all young women diagnosed with cancer."
However, potential risks include the possibility that tissue taken for cryopreservation may harbour seeds of malignant cells overlooked by current screening methods and so could induce a recurrence of the disease after reimplantation. This problem has been seen in animal models. Ethical questions concern the possibility of women delaying menopause and extending their reproductive lives.(London Debashis Singh)