For most girls, 9 years old is a bit early to be planning a family.
But fortunately for Moaza Al Matrooshi, her parents planned well ahead of time.
Their decision 15 years ago to have their daughter’s right ovary removed and frozen before she underwent chemotherapy made it possible for Al Matrooshi to deliver a healthy baby boy late last year when she was 24 years old.
Al Matrooshi was born with beta thalassemia, an inherited blood disorder. Left untreated, it could be fatal. So, when she was 9 years old, Al Matrooshi was treated with chemotherapy and a bone marrow transplant.
Her parents were worried that chemotherapy would damage Al Matrooshi’s ovaries and leave her infertile. So, in 2001 they opted to have her undergo ovarian tissue cryopreservation at the University of Leeds in the United Kingdom.
Dr. Zain Al-Safi, a fertility specialist with UCLA’s Fertility and Reproductive Health Center, described this procedure to Healthline, “You get the ovaries before exposure to chemotherapy or radiation. When the patient is stable and able to carry a pregnancy — in consultation with their oncologist — surgeons transfer the ovaries back to her body so she can achieve pregnancy.”
Two years ago Al Matrooshi was ready to try to have a baby. So doctors in Denmark transplanted the ovarian tissue back into her body. Four pieces were attached to her left ovary and one to the side of her uterus.
Within three months of the tissue implantation, her hormones levels were back to normal — one of the side effects of destroying the ovaries is premature menopause. Doctors described her as having the ovary function of a woman in her 20s.
To improve the chance of her conceiving a baby, doctors used in vitro fertilization (IVF) to produce three embryos. They implanted two of these into her uterus early last year.
A healthy baby boy, delivered at London's Portland Hospital for Women and Children last December.
Al Matrooshi still has one embryo in storage for when she decides to have another child.
The first baby born from cryopreserved ovary tissue was delivered in 2004 in Belgium.
This method is still considered experimental, but thousands of women have banked their ovarian tissue in hopes of achieving pregnancy later in life, as reported by the Chicago Tribune.
At least 60 babies have been born through this method.
Al Matrooshi is thought to be the first woman to give birth from ovarian tissue frozen before she reached puberty.
Other standard-of-care methods are available to women for preserving their fertility — including freezing the eggs or embryos.
These procedures, however, are not suitable for all women because they require the use of hormones to stimulate the ovaries in order to obtain the eggs.
“In pre-puberty, you cannot stimulate the ovaries to retrieve these eggs,” said Zain Al-Safi. “The only way that you can do that is [to wait until] after girls hit puberty.”
Even then, fertility clinics may not do this procedure on younger teenage girls.
Stimulating the ovaries to obtain mature eggs also takes around two weeks, which can delay a woman’s cancer treatment.
That leaves younger women undergoing chemotherapy or radiation treatment with few choices for being able to have a baby later in life.
“For pre-puberty girls that are diagnosed with cancer and are about to receive a treatment that condemns the ovaries,” said Al-Safi, “the only option would be ovarian tissue cryopreservation.”
Another fertility treatment that is being explored is in vitro maturation (IVM). This experimental method would provide an alternative to IVF.
With IVF, ovaries are stimulated using hormones in order to obtain mature eggs, ones that are ready to be fertilized by a sperm.
IVM allows doctors to obtain immature eggs from the ovary and mature them in the lab.
Pregnancy rates with IVM have been lower than with IVF, but some researchers are working on using growth factors to mature the eggs in the lab for better outcomes.
Because immature eggs are retrieved during IVM, women don’t have to undergo the same hormone therapy that is needed during IVF.
IVM is also quicker, which might be a better fit for younger women who have a short window of time before undergoing cancer treatment.
“In the case of pre-puberty girls,” said Al-Safi, “when ovarian tissue is obtained, instead of freezing the tissue, we can obtain eggs from that tissue and mature them in culture in the lab. And then freeze mature eggs instead of freezing the tissue.”
Doctors are working on other ways to help women give birth.
In 2014, a woman in Sweden gave birth to a healthy baby after having a uterus transplant.
A similar surgery last year at the Cleveland Clinic — the first uterus transplant in the United States — failed due to a yeast infection.
Even further down the road — still in the laboratory phase — researchers at Northeastern University are studying whether the ability of salamanders to repair their own ovaries could someday help women with infertility.