New option for fertility preservation in children reported

Egg or embryo freezing is the most common option for menstruating women trying to preserve their fertility before chemotherapy or radiation for cancer. But what about children before they start menstruating?

An article in the Washington Post reports on a new option from a study in Human Reproduction. Doctors in Belgium tried to restore the fertility of a woman using ovarian tissue removed from her when she was just 13.

It worked: The 27-year-old woman delivered a healthy baby boy late last year. The Belgian doctors who reported the case Tuesday in the journal Human Reproduction write that it is the first live delivery of a baby conceived after a transplant of childhood ovarian tissue.

“This is an important breakthrough in the field because children are the patients who are most likely to benefit from the procedure in the future,” Isabelle Demeestere, a gynecologist and research associate at Erasmus Hospital in Brussels, said in a news release. “When they are diagnosed with diseases that require treatment that can destroy ovarian function, freezing ovarian tissue is the only available option for preserving their fertility.”

In this case, the woman (whose identity the authors did not reveal) had severe sickle-cell anemia as a child and needed to undergo chemotherapy for a bone marrow transplant — a process that would effectively leave her unable to conceive. So at 13 years and 11 months, before she began menstruating, doctors removed her right ovary and some ovarian tissue. Her left ovary eventually failed, and she needed hormone therapy to menstruate.

A decade later, she wanted to have a baby. So doctors stopped the hormone therapy, thawed some of her frozen ovarian tissue and then grafted fragments onto her failed ovary and elsewhere in her body. Within five months, the tissue grew follicles with maturing eggs and she began having regular periods on her own. But her partner, the doctors write, had infertility issues.

Then, at 27, the woman conceived naturally.

“After more than two years post-transplantation, the patient had a spontaneous pregnancy with a new partner and spontaneously delivered a healthy boy in November 2014,” the authors write.

Although the newer case may signal hope to girls facing the prospect of procedures that would leave them unable to conceive, Demeestere cautioned that further research is needed to determine whether fertility could be restored using ovarian tissue removed from prepubescent girls. The woman in the Belgium case, the authors write, showed signs of starting puberty a few years before doctors harvested her ovarian tissue.

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