"When you walk on the edge of a
cliff like the Grand Canyon, you're not supposed to
look down because you get dizzy and it kind of scares
you. When I looked away from the microscope to see what
we were really suturing, I got really scared because
it just looks like it's going to tear apart," said veteran
micro-surgeon Dr Sherman Silber of his harrowing yet
successful ovary transplantation on Joy Lagos, a woman
who became menopausal in her late 20s after a battle
with non-Hodgkins lymphoma.
Twenty-one days later the patient
is recovering well, and has even started to feel the
effects of her new ovary. "I feel a little more hormonal
than I have for a long time — a little more emotional.
I get affected by things like sad movies now," Mrs Lagos,
who turned 30 while recuperating in the hospital, says
with a chuckle.
Dr Silber performed the operation
on February 5 at St Luke's Hospital near St Louis. Mrs
Lagos was only the second North American to receive
a whole ovary transplant and the first non-twin. The
donor was her sister, Maeapple Chaney.
HOPE
OF DELIVERY
The operation wasn't Dr Silber's first brush with ovary
transplantion. About one month earlier, the infertility
treatment pioneer performed a similar operation on twins
(who haven't gone public with their story) which was
also successful. But it'll take about three months before
we know if either woman's fertility has been restored.
He's previously performed seven
surgeries where he implanted strips of ovarian tissue,
rather than whole ovaries. All of these patients received
donor tissue from twin sisters, and all of them eventually
resumed normal ovulation and menstruation. One recipient,
Stephanie Yarber, went public with the news that she'd
had two children since receiving the tissue transplant
in 2004.
The problem with transplanting
only strips of ovarian tissue, explains Dr Silber, is
staying power. The procedure is likely to only buy a
few years of ovarian function, while a whole ovary transplant
might last much longer. "If they want to have longterm
natural ovary function for decades instead of just two
or three years to have a baby — [whole ovary transplantation]
is the way you have to do it," says the doctor.
Back in 2002 the Chinese media
reported a successful whole ovary transplant at the
Zhejiang Medical Science University. The surgeon, Dr
Zheng Wei, told China Daily that his 34-year-old patient,
Tang Fangfang received the ovary from her sister. Like
Joy and Maeapple, Ms Fangfang and her sister were unusually
close tissue matches for non-twins, so no anti-rejection
drugs were needed.
IDEAL
CANDIDATE
Joy and her husband Rodrigo were intrigued by the case.
The scientifically literate Mrs Lagos (who completed
pre-med studies prior to getting stricken by cancer)
was frustrated by the lack of published evidence on
the case. But everything changed when her husband caught
a news report of Dr Silber's work on television. They
were convinced that she was a perfect candidate. While
she didn't have a twin, she had a sister who'd already
donated bone marrow without any rejection issues.
"I was fully ready to argue my
case," Mrs Lagos insisted. Fortunately the US Air Force
veteran — she was a nuclear weapons technician
during the first Gulf War before she went back to school
— never even had to put up her dukes. She explained
her situation to one of Dr Silber's assistants and the
surgeon got back to her quite quickly. After testing
again to be absolutely certain of the genetic match
between the sisters, it was smooth sailing.
"We knew we had an ace up our sleeves
because of her sister being a genetic match," recalls
Mr Lagos. When they first met with Dr Silber in December,
the plan was to go forward with the tissue strip procedure.
But the surgeon called back soon after to say that based
on his research, a full ovarian transplant might be
appropriate.
The risks for Mrs Lagos, he explained,
were just the usual ones associated with any surgery
— clots, infection, etc — but her 31-year-old
sister faces the possibility of entering early menopause
as a result of donating an ovary.
FOR
YOUR PATIENTS?
Sadly, it seems unlikely that this procedure will become
common practice. First, ovary donors would be hard to
come by. And Dr Silber feels that we don't yet know
enough about the effects of anti-rejection drugs on
a recipient and potential fetuses, should she become
pregnant. "If they're not a close match, we're not ready
to tackle that yet," Dr Silber told the Associated Press.
And then there's the difficulty of the procedure itself,
which involves attaching the fragile, thread-like artery
of the donor ovary to the recipient.
But Joy Lagos hopes to see this
treatment one day become an option for all prematurely
menopausal patients. "I would tell anyone who could
to just go for it. If someone is interested in getting
more back than just being able to have children and
if it's important for them to feel the effects of their
hormones, then definitely this is worth it," she says.
"Your oncologist is primarily concerned
with saving your life — and that's understandable.
I was physically fine after beating cancer — except
I didn't feel like a 27-year old woman. It just felt
like something was missing," she explains.
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