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US woman gives birth to daughter after transplant of ovarian tissue from her twin

BMJ 2005; 330 doi: https://doi.org/10.1136/bmj.330.7505.1408-b (Published 16 June 2005) Cite this as: BMJ 2005;330:1408
  1. Janice Hopkins Tanne
  1. New York

    An American woman has given birth to a baby after a successful transplant of ovarian tissue from her identical twin sister. Two previous ovarian transplants have been reported, one in Belgium and one in China.

    Stephanie Yarber, aged 25, gave birth to a healthy daughter on 6 June, 15 months after receiving an ovarian transplant from her identical twin sister, Melanie Morgan.

    The event was reported in an early release paper on the website of the New England Journal of Medicine on 7 June (http://www.nejm.org/,dx.doi.org/10.1056/NEJMoa043157). It was also reported in national and international news media and on the website of the doctor who did the procedure, Sherman Silber from the Infertility Center of St Louis at St Luke's Hospital in St Louis, Missouri (www.infertile.com).

    The twin sisters are from the town of Muscle Shoals in Alabama. Ms Morgan has three naturally conceived children. Her twin, Ms Yarber, developed premature ovarian failure at the age of 14 and had not had menstrual periods for 10 years. At the age of 20, Ms Yarber had a laparoscopic examination and ovarian biopsy that showed atrophic elongated (“streak”) gonads and no follicles but a small uterus and an otherwise normal reproductive tract.

    Ms Yarber had two failed attempts at in vitro fertilisation, using eggs donated by Ms Morgan and fertilised by her husband's sperm. An internet search led the twins to Dr Silber for a possible transplant of ovarian tissue. Genetic fingerprinting confirmed that the twins were indeed monozygotic.

    On 21 April 2004, Dr Silber removed Ms Morgan's left ovary under general anesthesia. “The ovarian cortical tissue was trimmed to a thickness of 1 to 2 mm by excising medullary tissue and bursting small antral follicles,” according to the report. The dissection took less than an hour.

    Ms Yarber had a minilaparotomy and the cortex of each streak ovary was resected under a microscope, exposing the raw surface of the medulla. No follicles were seen. A section of about one third of her sister's ovarian cortex was laid over the raw medulla of each ovary and sutured. The remaining third of the donor ovarian cortex was frozen for possible future use if the graft ceased to function.

    Genetic examination of peripheral lymphocytes, ovarian cortex, and ovarian medulla from both women showed a normal 46, XX karyotype and no structural chromosomal abnormalities that would explain Ms Yarber's premature ovarian failure.

    Grafting of ovarian cortex is less invasive and involves less risk and shorter recovery time than a vascular graft, the authors say. But Dr Silber previously reported a testis transplant between male homozygous twins, one of whom had anorchia. (Fertility and Sterility 1978;30:181-7). The recipient now has four children.

    Eighty days after transplantation, Ms Yarber had a one day menstrual period, and 142 days after transplantation she had a heavy menstrual period. Ultrasound examination five weeks after her second menstrual period (176 days after transplantion) showed a normal intrauterine pregnancy. Two further ultrasound examinations were normal. She gave birth to a baby girl, named Anna, by vaginal delivery at 38 weeks.

    Dr Silber and colleagues say that the procedure is likely to remain rare, since few infertile women have a fertile identical twin sister. If the recipient and the donor of a transplant are not a good match, then the recipient has to take immunosuppressant drugs, which cannot be used in pregnancy. However, he told CBS news that he has since done transplant surgery on two other sets of identical twins.

    Last year, a Belgian woman received her own ovarian tissue back after cancer treatment and gave birth to a baby, although a question was raised over whether the ovum that resulted in the birth came from the reimplanted tissue or from the ovarian tissue that had remained in her body (Lancet 2004;364:1405-10, corrected in Lancet 2004;364:2020 and Lancet 2004;364:2091-3).

    In 2002, a Chinese woman was reported to have received an ovary and its fallopian tube from her sister in an operation at Zhejiang Medical Science University in eastern China in an attempt to restore fertility. The woman's own ovaries and tubes had been removed when she was treated for ovarian cancer. Because her sister was reported to be a near perfect tissue match, the recipient did not need immunosuppressant drugs (New Scientist 4 April 2002).

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