Ovary Donation Leads to Birth

An infertile Alabama woman has given birth to a healthy baby after receiving a transplanted ovary from her twin sister, the first case in which such a transplant has unequivocally resulted in a birth.

The achievement is considered a significant step toward restoring fertility in women who have undergone cancer therapy.

Stephanie Yarber, 25, of Muscle Shoals gave birth to a 7-pound, 15-ounce girl a little over a year after undergoing the transplant at a St. Louis hospital, researchers said in a report published online Tuesday by the New England Journal of Medicine.

Belgian researchers last year reported a successful birth by a woman whose ovarian tissues had been removed and frozen during chemotherapy, then reimplanted.

But critics argued that it was equally likely that the woman was able to give birth when her ovaries spontaneously recovered after the treatment.

“There is much less doubt in this case,” said Dr. Kutluk H. Oktay of Cornell-Weill Medical School in New York City, who was not involved in the transplant. “I think this is 99% convincing.”

The circumstances of the U.S. pregnancy are unique -- an infertile woman receiving an ovary from her reproductively normal, identical twin.

“It’s a remarkable accomplishment,” said Dr. James A. Grifo of the New York University School of Medicine, but the specific procedure “is not going to help a lot of patients” because most women don’t have an identical twin.

But experts argued that the procedures used in the transplant were identical to those that would be used to reimplant a woman’s own reproductive tissues after chemotherapy.

“There are tens of thousands of women who lose fertility as a result of chemotherapy,” Oktay said. “This is another proof of principle for ovarian transplantation.”

For unknown reasons, Yarber had not had a menstrual cycle since she was 13. Her twin, Melanie Morgan of Tuscumbia, Ala., had normal cycles and had borne three children.

Two attempted egg donations by the healthy twin were unsuccessful. In April 2004, the pair underwent a procedure developed by Dr. Sherman J. Silber of St. Luke’s Hospital in St. Louis and Dr. Roger G. Gosden of Cornell-Weill.

In a five-hour procedure, Silber and his colleagues removed one ovary from Morgan and sliced away the segment called the cortex, which they divided into three pieces. One piece was frozen for future use, while the other two were implanted in Yarber’s ovaries.

Transplant drugs were not needed after surgery because the women are genetically identical.

By September, Yarber was having normal menses and in October she became pregnant “the old-fashioned way,” Silber said.

The pregnancy was uneventful and, after 38 weeks of gestation, Yarber had a normal vaginal delivery Monday, the research team said.

Physicians have been working for at least seven years to develop ways to remove and store ovarian tissue for women who are about to undergo chemotherapy or radiation treatments that would kill undeveloped eggs.

Oktay and his colleagues have reported success in restoring menstrual cycles in a handful of women using their frozen ovary tissues, but the women have only one or two cycles before again becoming infertile.

The freezing and thawing are pretty straightforward, Oktay said Tuesday. It’s the reimplantation that has proved difficult, so Silber’s success is a step forward.

In September, Dr. Jacques Donnez of Catholic University of Louvain in Belgium reported the birth of a baby girl, Tamara Touirat, after reimplantation of frozen ovarian tissue seven years after Tamara’s mother, Ouarda, began chemotherapy for Hodgkin’s disease.

But critics such as Oktay said that recovery of ovarian function, while rare, was not unheard of. Critics estimated that the odds were about even that the birth resulted from the transplant.

Donnez reported earlier this year that he had restored menses in another woman, but she had not yet become pregnant.

In a more radical approach, Dr. Carina G. Hilders and her colleagues at Reinier de Graff Hospital in the Netherlands reported last year that they had successfully transplanted a young woman’s ovary into her upper arm, out of reach of radiation treatments. The tissue had normal cycles and continued to produce an egg every month, they reported in the journal Cancer.

They have not reported attempting to reimplant the tissue.