We often discuss the many ways young people can preserve their fertility prior to undergoing medical procedures that may leave them sterile. One of these fertility preservation options, ovarian tissue cryopreservation, or freezing, has recently been reported in the Lancet medical journal, to also successfully be used to induce puberty in a 13 year old girl who had undergone a stem-cell transplant.
The authors of the study, Poirot, Abirached, Prades, Coussieu, Bernaudin, and Piver, report the case of a young girl with severe sickle-cell anemia. Sickle-cell anemia, or disease, is a recessive genetic disorder that causes the red blood cells to take on an abnormal “sickle” shape, which can cause reduced hemoglobin (carries oxygen to the bodily organs) and decreased blood flow. Sickle-cell disease can cause variety of symptoms including swelling of the digits, fever, chest pain, difficult breathing, and premature death.
In the case, a young girl’s sickle cell disease was so severe that she chose to undergo stem-cell transplantation. Prior to transplantation, patients may undergo total body irradiation or high levels of chemotherapy, which can often destroy their fertility, before the infusion of donor stem cells that may cure their disease. Before undergoing the irradiation, the 10-year old girl had one of her ovaries removed through a laparoscopic procedure, dissected into 23 pieces, and then frozen.
Three years later, at age 13, the girl returned to her clinicians with a problem. She had not yet shown evidence of entering puberty. The doctors then reimplanted 3 thawed pieces of her ovarian tissue in an attempt to induce puberty. Within two months, she started to develop breasts and pubic hair, and eight months after the graft, the girl had her first period. This is the first published report of ovarian tissue reimplantation for the express purpose of inducing puberty.
It is important to note a few things in this case. First of all, the clinicians in the case implanted the ovarian tissue in the abdomen, not in the normal location of the ovary, as the purpose was to induce puberty, not pregnancy. Secondly, though the procedure was a success, the girl’s menstrual cycles continued normally only for about two years and became irregular afterward. Thus, if she wishes to become pregnant later in life she may need to reimplant some of her remaining ovarian tissue. Further effort by oncofertility researchers will be needed to 1) determine if ovarian tissue can reliably induce puberty in girls, 2) understand how ovarian tissue can be used to grow ovarian follicles in vitro, and 3) develop stem cell and cancer treatments that do not impact the hormonal health and reproductive potential of children.