Preserving fertility -- One Woman's Story

Ovarian tissue that may someday bring fertility to a patient

In this story: Freezing ovaries: the technology Safety studied RELATED STORIES, SITES

From Rhonda Rowland
CNN Medical Correspondent

(CNN) -- Hope Merrill, 37, is the epitome of a successful career woman. She started her own publishing company 15 years ago. When she's not working, Merrill spends time on her ranch with her husband and horses. She always wanted to have children, but not until she felt she had the time to spend with them. Like many busy women, Merrill eventually felt her biological clock ticking.

"I thought one day I'll get to the babies. And then at 35 I think I just kind of said 'whoa!' wait a minute. Maybe I better stop trying not to, and at least be thinking about having children," said Merrill.

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But there was a major glitch in her plan -- doctors diagnosed her with breast cancer.

"It's impossible to describe what that feels like. It is devastating. You think your life is over and truly your life as you know it is," she said.

After having surgery to remove the cancer, Merrill had six weeks before she would begin chemotherapy. That's when she started reading and discovered it was likely the treatment would make her sterile.

"Those two facts became very apparent, that one, I'll most likely be sterile. And I have no family and there's really not a lot I can do about that."

She described what happened next as fate. She was reading a business magazine and came across an item about Reproductive Biology Associates of Atlanta. The fertility center was doing research that could eventually help women with cancer. They were removing ovarian tissue and freezing it.

"If we could remove ovarian tissue in very large quantities and freeze it and learn how to put those tissues back correctly in the right place, given the optimal conditions, perhaps we might be able to provide ovarian function in those patients," said Dr. Dorothy Mitchell-Leef of Reproductive Biology Associates.

"I picked up the phone and called," she said.

It was just in the nick of time.

"I had the ovary removed on a Friday and had my first chemotherapy the next Monday. It was amazing."

That was two years ago. Merrill will not even consider starting a family for another three years. If the cancer does not come back, five years after treatment, doctors will consider her cured.

"I was banking on in five years they would have the technology ready so that we could have children. Even if in five years I chose not to use the tissue, it might help someone else."

No one has achieved a pregnancy from frozen ovarian tissue yet.

Last year Dr. Kutluk Oktay from Cornell University transplanted a section of a woman's ovary into her forearm. Egg development and normal hormone production was achieved. Theoretically, the eggs could be removed and used for in vitro fertilization to achieve a pregnancy. Dr. Oktay had similar results with a second patient.

Researchers at the Jones Institute at Eastern Virginia Medical School say they've achieved encouraging results with ovarian transplant in 16 Cynomologous monkeys. The findings are being presented at the American Society for Reproductive Medicine meeting in San Diego. One group of monkeys had frozen ovarian tissue transplanted back into the upper arm.

"We found that with the transplantation of the frozen ovarian tissue, we had a 50-percent success rate," said Dr. John Schnorr of the Jones Institute. "We've demonstrated normal estrogen function, normal progesterone production and the production of mature eggs. Eggs that are capable of being fertilized. We were not able to complete the fertilization step because we didn't have approval for that experiment. I think our research bodes well for starting human research protocols."

Vials of frozen tissue await the technology to use them fully

Most researchers choose to transplant the ovarian tissue into the arm because it's an easy area to monitor and is accessible. Surgeons also have a lot of history with transplanting tissues in the arm for other medical conditions. Some researchers have experimented with transplanting the tissue in the abdomen.

"This technique also has potential for women who are at high risk for ovarian cancer," said Dr. Schnorr. "They could have their ovaries removed, part of it frozen. The other part put back into the upper arm, which is easily monitored. If there was a progression to ovarian cancer, it would be caught a lot earlier."

Dr. Schnorr says the technique could also be applied to egg donation. And, down the road to healthy woman who are delaying childbearing.

"If a woman is 30 years old and has not met the partner of her dreams, she can potentially have a piece of her ovary removed and frozen for later use with ovarian transplant technologies," said Dr. Schnorr.

But Dr. Mitchell-Leef doesn't think women in their 20's or 30's who haven't found Mr. Right should consider freezing part of their ovaries just yet.

"I'd hate to think they put one of their ovaries in the bank and we hadn't quite broken the code," said Dr. Mitchell-Leef. "There are still questions we need to answer like how do we freeze and thaw them appropriately for ovarian function. In the primate study the animals were very young, so what kind of results can we get in older women."

Recent studies looked at the safety of and efficacy of using cryopreserved ovarian tissue. A team from the University of Bologna studied 11 pregnancies from frozen eggs, which resulted in 13 children. In all but one of the pregnancies, amniocentesis was performed, showing that all of the fetuses were normal. They report that the gestational age at delivery was normal, and post-natal growth and development have all been reported normal.

A team of researchers from Argentina reported that they had frozen and thawed ovarian tissue and found no significant damage. And Canadian scientists successfully removed ovarian tissue from women, froze it, replanted it into mice and were able to establish follicular development.

"This work shows that we are on the cusp of being able to offer new hope to many young women facing premature menopause," said Dr. R. Jeffrey Chang, head of the American Society for Reproductive Medicine.

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