A new ovary transplant procedure may offer a way to reverse the menopause, correct some cases of infertility, halt the effects of ageing and allow women in their 60s to conceive.
Prof Roger Gosden, of Leeds University, whose work has led to the reversal of the menopause by an ovary graft operation, predicted the procedure would have profound implications and raise ethical issues.
He outlined his work yesterday at the annual meeting of the American Society for Reproductive Medicine in Toronto. The fertility of a previously sterile woman - Ms Margaret Lloyd-Hart (30), from Arizona - was restored by transplanting ovary tissue. She had gone through a surgically-induced menopause some years previously.
The restorative operation was performed at New York Methodist Hospital by Dr Kutluk Oktay in February. It was made possible only because she had decided to freeze one of her ovaries which had to be removed when she was 17 because of cysts. Doctors had hoped that in the future the preserved ovary might be used to restore her fertility.
Through keyhole surgery, the ovarian tissue was put back in her body with a view to the ovary resuming its normal function, including producing hormones and releasing viable eggs. More than 60 segments of ovarian tissue were stitched in a chain and transplanted into the patient's pelvic wall. Recently, the reconstructed ovary was stimulated and produced an egg. The implications of the technique have created new ethical dilemmas. It raises the possibility that younger women will routinely remove and store their ovaries to control their fertility yet retain their options later and/or overcome the effects of cancer treatment should the need arise.
The headlines may talk of reversing the menopause, babies for women in their 60s and reducing ageing effects, but Prof Gosden put a calmer perspective on his work. "This is proof of the principle that ovary grafts could be used to rescue fertility. There is no reason why ovaries could not be stored for decades."
He told the Daily Telegraph, which broke the story: "We have to be cautious. This is not something that will help everybody. At the moment, we just see it as an emergency strategy."
He believed the immediate impact would be in fertility control, describing such procedures as "primarily for fertility conservation", though he accepted many would view them as an opportunity to provide women with "more choice about hormones".
Dr Oktay also underlined its fertility role. "It will enable patients to prolong their reproductive life span, as banked ovarian tissue doesn't `age'." The potential benefits include:
protecting fertility in women undergoing cancer treatment; it could be grafted into the forearm, and eggs when riped under the skin could be returned to the fallopian tube or undergo typical IVF development in a petri dish before being returned to the womb.
allowing women in their 40s to have late pregnancies;
an ovary graft may increase their chances and improve egg quality; reducing the risks of miscarriage or genetic defects.
treating sterility caused by premature menopause this affects one in every 100 women, while the technique may eventually allow women born with Turner's Syndrome, and having no functioning ovary, to become fertile;
delaying the menopause and arrest ageing as an alternative to hormone replacement therapy. More controversial possibilities include ovarian transplantation from another donor, or from an aborted foetus (the richest source of eggs) to restore female fertility.
