Like many cancer patients, Vali knew that her ovaries would be damaged by chemotherapy and radiation treatments. So she sought the help of the Melbourne IVF Clinic at the Royal Women’s Hospital of Melbourne in Australia. The team there, led by associate professor Dr. Kate Stern, removed and froze her ovaries before the cancer drugs could destroy them.
Once Vali, known only by her first name, had recovered, she and her partner, Dean, wanted to have children. After carefully screening the ovarian tissue to make sure it was cancer-free, Stern implanted samples into Vali’s abdomen. The tissue attached to the abdominal wall and grew into the body’s system of blood vessels, giving it a blood supply as well as a way to deliver hormones to the rest of the body.
“The graft takes about four months to start working, making hormones and recommencing the menstrual cycle with egg development,” explained Stern, a fertility specialist and reproductive endocrinologist, in an interview with Healthline. “It is still hard to get good quality eggs from a graft—it doesn’t function exactly like a ‘normal’ whole ovary."
From there, Stern was able to extract eggs and fertilize them using standard in-vitro fertilization (IVF) techniques. In IVF, eggs are removed from a woman’s ovary and mixed with her partner’s sperm in the lab to produce embryos, and then the embryos are implanted into her uterus.
When the ovaries are removed or destroyed by cancer, a woman doesn’t just lose her fertility; almost immediately, she enters menopause. With the reintroduction of hormone-producing ovarian tissue, her reproductive system can be kickstarted again, as long as her other reproductive organs are intact.
Still, it’s an uphill battle. “It takes a long time to get good eggs,” Stern said. “It's a lot of hard work. Vali had treatment for nearly two years before we got two good eggs.”
A Mother at Last
Today, Vali is pregnant and expecting healthy twins.
IVF has advanced by leaps and bounds in recent years. “There have been 29 babies born already from putting frozen-thawed ovarian tissue back in the ovary or near it,” Stern said. “What we've done is put the tissue a long way away from its natural environment, and it's still worked.”
For many women, implanting the tissue near ovarian sites will be the best solution. But for some, that isn’t possible.
“Certain locations work better than others for different patients,” Stern explained. “The abdominal location is the only option for women who've have severe pelvic disease. For example, someone who's had bowel cancer has had so much surgery, it would be dangerous to put tissue back in the pelvis. For other women, it expands the opportunities—it means you can put tissue inside the pelvis and outside the pelvis and see what works.”
In addition to preserving fertility for women undergoing cancer treatment, this transplant technique also offers hope for girls and young women who are facing early menopause. Entering menopause as a 19-year-old can have an abrupt and severe impact on a woman's quality of life.
“In young girls who develop early menopause or who have cancer treatment when they're very young, and lose their potential normal pubertal development fertility and potential development, you can put the tissue back, and they can undergo normal puberty,” Stern says.
Although it may be years before the Melbourne team’s technique is widespread, this technology provides new options for women whose reproductive futures are uncertain.