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Twins' Ovarian Transplants Are Proving Successful


 

PRAGUE — Ovarian transplantation in five sets of monozygotic twins who were discordant for ovarian failure has not only resulted in normal menstruation and ovulation in all recipients, but also one healthy birth and three more ongoing pregnancies, Dr. Sherman Silber reported at the annual meeting of the European Society of Human Reproduction and Embryology.

“What we once thought would be a rare thing is now a series, with great implications beyond these special cases,” said Dr. Silber from the Infertility Center of St. Louis.

Last year at the same meeting, Dr. Silber reported his first of such transplants (N. Engl. J. Med. 2005;353:58–63) from a fertile twin to her sister.

The donor, who had three naturally conceived children, had one ovary laparoscopically removed. One-third of the tissue was frozen for the donor to use in the future, and the other two-thirds were transplanted into the recipient, who had experienced premature ovarian failure at age 14.

After the procedure, the recipient conceived in her second menstrual cycle and gave birth to a healthy girl. She has since conceived again and the delivery of her second child is expected soon.

Since Dr. Silber's initial report of this procedure, he has performed it successfully in four other monozygotic twin pairs, two of whom have conceived.

The third recipient is trying to conceive and the fourth is waiting to finish her medical training before trying to get pregnant. “This is not an arduous or difficult procedure for either patient,” noted Dr. Silber in an interview, both the donor and recipient can return home the next day.

“It is much like a laparoscopy with lysis of adhesions.” The advantage of the procedure over egg donation is that it allows long-term fertility and natural conception, he added.

He reported that the postoperative pattern for all recipients is very similar, with the resumption of menstruation occurring roughly 2.5 months post procedure and ovulatory cycles generally resuming another 2 months after that.

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