Tens of thousands of women freeze their eggs every year in order to maintain their fertility. However, what if a woman is unable to freeze her eggs? This was the case for Annie Dauer who was diagnosed with Hodgkin lymphoma at 28 years old. Unfortunately, current treatments for Hodgkin lymphoma were almost guaranteed to leave Annie infertile. With only one weeks notice, Annie was unable to freeze her eggs and instead had to resort to an experimental therapy in an effort to preserve her fertility. This experimental therapy is known as ovarian cryopreservation and transplantation but is more commonly referred to as “ovary freezing.”
At 32 years of age, Annie had officially been in remission for 2.5 years and requested an ovarian transplantation as she and her husband now desired children. However, she had also been in menopause for 2.5 years due to her chemotherapy treatment. The ovarian tissue was thawed, tested, and implanted subcutaneously in the lower abdominal region. It was believed that the ovarian tissue only needed to be reimplanted in the body in order for the tissue to excrete eggs that could be used for in vitro fertilization (IVF). However, two months following the ovarian tissue transplant Annie discovered that she was pregnant during a doctor’s visit. Given that IVF had not taken place, the most likely solution to this conundrum was that the reimplanted ovary tissue had stimulated the previously menopausal, intact ovary to start ovulating eggs once again. Although the first pregnancy was lost, Annie was able to successfully conceive another child just two months later. This child was eventually carried to full term. The mechanism with which the previously menopausal ovary became fertile is not well understood. However, the fact that a previously menopausal woman was able to naturally conceive and deliver a healthy baby, following an ovarian tissue transplant, provides hope for yet another potential option that will allow women to maintain their fertility.
I was also glad to hear that Annie's physicians were able to work together in a successful effort to help maintain Annie's fertility and therefore, her autonomy. Becoming infertile at the young age of 28 can be very difficult for anyone and the fact that these two physicians were able to work together to get Annie into a clinical trial, in order to help maintain her autonomy, says quite a bit about this patient-physician relationship.
This is an interesting case study. I’m certainly in support of eliminating barriers which prevent women from bearing their own children. However, it is not clear when and for whom the procedure is most appropriate. An article I found suggests that it should be primarily aimed at those with a clear need. An unstudied, yet potentially dangerous risk factor includes malignant contamination. In cases where women undergo treatment before chemotherapy, there is a chance that some of the collected tissue may include cancerous cells. As far as timing goes, the procedure may be best after a few rounds of chemotherapy, or for patients who know that there are no malignant cells present in the ovaries. I hope they continue to research this option and make it more accessible and safer for women.
ReplyDeletehttps://academic.oup.com/hropen/article/2017/1/hox001/3092402