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Medical Video: Conception After Chemo? One Woman's Inspiring Fertility Story - Alvarado Hospital
In the early 2000s, the first news of the birth of a woman who underwent ovarian transplant surgery offered a glimmer of hope to millions of women worldwide with infertility problems, including those who experienced early menopause, and who underwent chemotherapy and radiotherapy treatments for cancer.
Thanks to improvements in cancer treatment, many young women are able to fight cancer and enjoy long life and normal life. But in 80 to 100 percent of women undergoing cancer treatment, such as chemotherapy and radiotherapy, early menopause and general ovarian damage occur as a result, which means the body produces no eggs and women cannot get pregnant. Even if the ovaries return to function as usual after treatment, cancer survivors often have difficulty getting pregnant because the quality of their eggs is impaired. Conversely, if he succeeds in becoming pregnant, he can face a higher risk of miscarriage or premature labor.
Ovarian transplantation sounds like a science fiction film - dissecting the human body to take one organ and then replanting it when needed. But in reality, this extraordinary procedure was successfully carried out.
How is the ovarian graft surgery performed?
This operation is still quite experimental and very special. Basically, this procedure can be carried out by removing the ovaries themselves before carrying out cancer therapy or transplanting donor ovaries. If you use your own ovary, the doctor will offer to remove all ovarian organs or only partially before the patient starts cancer treatment so that it can be frozen and stored. Once complete therapy, the ovary can then be implanted back into the body.
Removal of the ovary is done through microsurgical surgery with a very small incision, which is only 1-2 cm, aka keyhole surgery. Keyhole surgery allows postoperative recovery time to run fast enough. The ovary, which looks like a walnut, is then implanted using an open surgery technique in which small blood vessels will be reconnected so that the ovarian graft receives an adequate oxygen supply. Suturing these small blood vessels is part of the most subtle and longest-time procedure.
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By relocating ovarian tissue, doctors preserve the ability of women to produce healthy eggs that might later be used to try pregnancy through IVF. If the mother's womb is healthy, the fertilized embryo can be implanted in the uterus so that it can contain the fetus itself. If the condition of the uterus is not possible, a woman can choose to have a surrogate mom to conceive her child.
Is ovarian transplant surgery safe?
Ovarian tissue transplantation for women who want to have a baby after cancer treatment seems safe and very successful, according to a team of experts in Denmark, where this procedure is routinely offered. Denmark became the world's first pioneer in ovarian transplantation. In Demark alone, there were ten out of 32 women who had ovarian transplants and wanted to get pregnant successfully had a healthy baby, and the mother had no cancer recurrence as a result.
At least 36 babies have been born into the world after this procedure, most of them from Denmark. Half of the pregnancies are successfully conceived naturally, without the help of IVF. Germany, Spain, Israel and Belgium have also carried out a large number of these ovarian graft procedures.
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When the transplant is complete, it takes several months for the ovary to begin to function normally. But in the Journal of the American Medical Association, Dr. Kutluk Oktay and colleagues, reported from ABC News, reported that re-implanted ovaries (whether owned by themselves or from donors) functioned as they did; releasing reproductive hormones, restoring regular menstrual cycles, and most importantly for fertility, producing mature eggs that look healthy and normal. The reason this technique works so effectively is that not all female eggs are in their ovaries, but in the outer capsule.
So doctors don't actually freeze and thaw the ovaries. They only freeze a thin piece of ovarian tissue, like a simple skin graft. Therefore ovarian graft is an outpatient procedure that involves minimum pain. Apart from preserving future fertility, transplant tissue has the added benefit of restoring hormone function and delaying menopause.
Who can be a candidate for ovarian graft?
At this time, it seems that the ovarian graft procedure can work in women who have a sister who can provide suitable ovarian tissue or the entire ovary. In several operations that have been carried out, ovarian transplants are carried out between identical twins, thus limiting tissue rejection problems.
For donors who want to donate their ovaries to women who are not related to the family, the organ and all the supporting tissues of the two must be very suitable, just like what happens with other organ transplants.
Ovarian grafts can also be done for women who will receive cancer treatment and therefore understand the consequences from the outset that they tend to be infertile. These women have the option of freezing their own ovarian tissue while they are menstruating. Women who suffer from other conditions treated with cancer drugs, such as blood, kidney and joint disorders, can also be candidates for this procedure. Fertility doctors have also said that women who suffer from osteoporosis may find that their condition improves after transplantation encourages a more regular menstrual cycle.
Ovarian grafts are still the topic of medical ethics debates
Fertility specialists are very happy about this new breakthrough for couples who have fertility problems. However, further research is still needed because the ovary transplant procedure is still in its early stages. Not to mention the meeting with a number of ethical pros and cons in the medical world.
Some fertility specialists have shown that this procedure can be beneficial for women who want to delay being parents for social or career reasons. Women who fall into this group are like being able to freeze their ovarian tissue and replant it when they are ready to have children. Critics question whether this is a proposal that deserves ethics and says that fertility specialists must focus their efforts and resources on couples who truly have fertility problems.
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Some unknown risks associated with the procedure, such as the possibility of cancer recurrence, also make some experts question whether couples should override other fertility therapies that are safer if there is a choice of ovarian grafts. A number of case examples above mostly involve fresh tissue grafts, while cancer patients will need to freeze their ovarian tissue for future use. The function / thawed frozen ovarian tissue has not been promising. On the other hand, not every transplant procedure has ended in a successful pregnancy.
Experts advise women to investigate all their choices before putting aside conventional fertility therapy methods. Grete Brauten-Smith, clinical nurse specialist Breast Cancer Care, reported by The Guardian, said young women who were facing cancer treatment had to be informed of the benefits and risks of each treatment recommendation of choice from a fertility specialist. "It is very important for women like this to be treated with referrals to a fertility expert before starting treatment. Only then will they be able to make independent and mature decisions about their future fertility. "
