A woman whose ovaries were damaged by chemotherapy and radiotherapy, has received a successful ovarian transplant from her sister.
The two are not genetically identical yet the transplanted ovary has restored the woman's ovarian function.
In 1990, when she was 20, Teresa Alvaro was treated for beta-thalassemia, an inherited blood disorder characterised by reduced or absent haemoglobin, which is the oxygen-carrying protein in red blood cells.
She received chemotherapy and radiotherapy before having a bone marrow transplant from her 17-year-old sister, Sandra Alvaro, who had an identically matched tissue type (human leukocyte antigen (HLA) type), which meant that Teresa’s immune system would not recognise her sister’s bone marrow as “foreign” and reject it.
The treatment was successful and Teresa was cured but at the time procedures to preserve fertility such as freezing eggs or ovarian tissue were unavailable.
Alvaro first sought help for her fertility problem in 2005 when she was 35; she consulted Professor Jacques Donnez and his colleagues head of the department of gynaecology and professor and chairman at the Catholic University of Louvain in Brussels, Belgium, about the possibility of ovarian tissue transplantation from her sister.
Professor Donnez says the option of oocyte donation from the sister was rejected in favour of a transplant.
Investigations showed that the sisters’ genetically different cells coexisted successfully together and no immuno-suppressive treatment would be required to prevent the ovarian graft being rejected.
In February 2006, Teresa and Sandra were anaesthetised together and three small sections of ovarian tissue were removed from Sandra via laparoscopy and within less than a minute were being sewn on to one of Teresa’s atrophied ovaries, also via laparoscopy.
The sisters were discharged from hospital the following day.
Six months later Teresa started menstrual bleeding and this, together with differences in hormone levels, confirmed that ovarian function had been restored.
A year after the transplant, the doctors retrieved two mature oocytes from her ovary and fertilised them with her husband’s sperm but though the resulting embryos developed to the two-cell stage and the other to the three-cell stage, both ceased to develop further, and were not transferred to her uterus.
Professor Donnez says it is unclear why this happened but more IVF attempts are planned.
Donnez says it is too early to say whether this procedure would ever be successful enough to enable a woman to become pregnant successfully and give birth to a live baby but it does offer hope to women who had not had an opportunity to freeze either their eggs or their ovarian tissue.
The revolutionary procedure has given Teresa fresh hope of children and also opens a new approach to restoring the fertility and menstrual cycles of thousands of women who have for some reason suffered premature ovarian failure.
The successful operation follows recent advances in ovarian grafting and transplantation; in 2004 another Belgian woman, Ouarda Touirat, gave birth after having sections of ovary tissue removed, frozen and reimplanted by Professor Donnez to preserve her fertility during cancer treatment.
Experts however say that such transplants are still unlikely to benefit more than a few women as it is necessary to have a donor who is a precise tissue match.
Also giving up ovarian tissue has health and fertility implications for the donor, and only women who have had their children, or do not want any, would be suitable candidates.
The case is published in Human Reproduction.