The first ovary transplant between women who are not identical twins has been performed successfully in Belgium, offering a new route to fertility for women who lose it because of an early menopause or medical treatment.

Teresa Alvaro, who is now 37, has started to menstruate again and has produced two eggs that have been fertilised with her husband’s sperm after receiving grafts of ovary tissue donated by her sister, Sandra, 34.

The revolutionary procedure, performed by Jacques Donnez, of the Catholic University of Louvain (Leuven), near Brussels, has given Teresa fresh hope of children. She became infertile aged 20 because of treatment for a rare blood disorder. It also opens a new approach to restoring the fertility and menstrual cycles of thousands of women who have suffered premature ovarian failure, usually as a result of chemotherapy for cancer or other diseases or an early menopause.

While a handful of ovary transplants have been conducted before, and at least one woman has given birth after the operation, all these procedures have involved identical twins. As such twins share all their genes, there is no risk of tissue rejection.

Teresa and Sandra are the first ordinary sisters to take part in a successful transplant, and their case shows that the technique can work for patients who do not have an identical twin.

Scientists cautioned, however, that such transplants are still unlikely to benefit more than a few women. For the operation to work, it is necessary to have a donor who is a precise tissue match. And as giving up ovarian tissue involves health and fertility risks to the donor, only women who have had their children, or do not want any, would be suitable candidates. Egg donation and other forms of fertility treatment are likely to remain the therapy of choice.

The successful operation, reported in Human Reproduction, follows recent advances in ovarian grafting and transplantation. In 2004 another Belgian woman, Ouarda Touirat, gave birth after having sections of ovary tissue removed, frozen and reimplanted by Professor Donnez to preserve her fertility during cancer treatment.

The following year, Stephanie Yarber, an American, gave birth after receiving an ovary from her identical twin, Melanie Morgan. Teresa Alvaro said that she had approached Professor Donnez after reading about the Yarber case in 2005. Her ovaries had failed in 1990 because of chemotherapy and radiotherapy for betathalassaemia, a blood disorder, which was ultimately treated successfully with a bone marrow transplant from Sandra, who is a perfect tissue match.

“I went to see Professor Donnez with my sister,” she said. “Our antigens appeared to be identical, and therefore the chances of rejection were minimal. “The operation was a success. I can get pregnant the natural way.”

In February last year Professor Donnez agreed to remove three slices from one of Sandra’s ovaries and stitch them on to one of Teresa’s atrophied ovaries. After six months, Teresa started having periods, and after a year the transplant doctors removed two eggs from her ovaries and fertilised them with her husband’s sperm. The embryos were not implanted as they failed to develop, but it is still possible that she could become pregnant.

Professor Donnez said: “Although the option of oocyte \ donation from the sister to the patient was discussed, the patient refused this option. She preferred a transplant because she wanted to be ‘responsible’ for the follicular maturation and considered that it was more natural than egg donation, for which her sister would have to undergo ovarian stimulation with follicle stimulating hormones and then oocyte retrieval. In addition, her sister had asked expressly to be the tissue donor and had refused to undergo ovarian stimulation for oocyte donation.

“This method is an option for women who have not had their ovar-ian tissue cryopreserved [frozen], either because chemotherapy was given before 1996, or because cryo-preservation was not proposed or not available in the hospital where the patient was treated.”

Age of regeneration

1999 Ovary tissue first stored, frozen and reimplanted to a woman’s arm, restoring her menstrual cycles, by team led by Roger Gosden and Kutluk Oktay

2003 First primate — a rhesus macaque monkey — born after ovary tissue frozen and reimplanted

2004 Ouarda Touriat, a Belgian woman, has first human baby, Tamara, after ovary tissue removed, frozen and transplanted. Operation performed by Professor Jacques Donnez, of the Catholic University of Louvain (Leuven) in Belgium

2004 First successful person-to- person ovary transplant. Stephanie Yarber, from Alabama, received ovary tissue from her identical twin sister, Melanie Morgan, and became pregnant. Operation conducted by Sherman Silber, of St Luke’s Hospital in St Louis, Missouri

2005 Ms Yarber has a healthy baby girl. A second birth, after ovarian cryopreservation and reimplantation, takes place in Israel

2005-06 Four other ovary transplants performed between identical twins

2007 First ovary transplant between sisters who are not identical twins, by Professor Donnez

Source: Times Database

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