PRINTOvary transplants provide a chance
Renewed health and a new hope of pregancy are among the benefits
April 26, 2007 | 10:26 a.m. CST
When most girls her age were just trying to understand their menstrual cycles, Stephanie Yarber had symptoms of menopause. At 13, she became one of the 250,000 to 1 million women in the U.S. with premature ovarian failure.
Sure, at first no more periods sounds like a sweet deal, but menopause at such a young age is anything but a lucky break. The cause of POF is often unknown, as in Yarber’s case. The average woman becomes menopausal at 51, but women with POF stop menstruating in their teens, 20s or 30s. Because the ovaries fail to function normally, infertility is a common outcome of the condition. Women with POF might also experience menopausal symptoms such as hot flashes and lower bone density.
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Yarber wanted to be a mother. She longed to feel a child growing and moving in her body and to experience labor, delivery and breast-feeding. Still, POF didn’t have a huge impact on Yarber until she met her husband, Kevin, and then saw her identical twin sister, Melanie Morgan, get pregnant. She became determined to have a child of her own.
“I just wanted the whole experience of motherhood,” she says.
To treat infertility in women, the familiar options are intrauterine insemination and in vitro fertilization. Ovarian transplants have become a new opportunity for some women with POF to not only bear children but also maintain their own natural hormones. At 24, Yarber read an article about a woman in China who donated her ovary to her sister. She began researching the procedure and found Sherman J. Silber, director of the Infertility Center of St. Louis. She didn’t know it at the time, but Yarber, now 27, had found the doctor who would give her the ability to become a mother.
Yarber’s mother, Vivian Fuller, always told her daughter not to give up hope. “We trust in God,” Fuller says. “My father’s a preacher. We’ve always believed, one way or the other, it would work out.”
Try, try again
Things were not as clear back when 13-year-old Yarber first noticed her menstruation had stopped. For six months, doctors didn’t know if it was a tumor, autoimmune disorder or a genetic disorder that was causing the problem. While Yarber went through numerous tests, doctors told the family that the condition could cause Yarber’s kidneys to shut down and other organs to fail.
“At that time, we didn’t know what it was,” Fuller says. She found it hard to explain to her daughter what menopause meant. “It broke my heart; I knew what it meant,” she says. “Her bones are getting brittle early and to face other problems you have in menopause when she’s only 13.”
It wasn’t long before Yarber had to face her infertility. She got married when she was 18, and the couple wanted to get pregnant soon after. They knew they would not be successful, though; Yarber couldn’t produce her own eggs. Morgan offered to donate eggs to her twin, and in 2001 they decided to try an in vitro fertilization procedure using Morgan’s eggs and Kevin’s sperm. But Morgan, who had to stop taking her birth control pills in preparation for the IVF procedure, got pregnant before her eggs could be collected. The trio completed a second and third IVF procedure in 2002 and 2003, but neither embryo transfer resulted in a pregnancy. After that, Yarber began to research adoption but soon learned of the possibility of an ovary transplant. Within the week, she had e-mailed Silber for more information.
Silber had already performed a testicle transplant in 1977 and had been researching and developing techniques to do an ovary transplant. When Yarber and Morgan came along, he had found the ideal candidates for the procedure: identical twins, one with POF and one without.
Yarber’s only concern was that the transplant might not work. “Once we’ve prayed about it, there is not anything we could do; we weren’t going to get the 100 percent guarantee that it would work,” Yarber says. Morgan never had doubts about helping her sister. “Because I knew that she wanted that more than anything, I wanted that for her,” Morgan says.
Gift of life
The family arrived in St. Louis one day before the scheduled surgery date, April 21, 2004. The twins went through pre-surgery checkups and multiple tests to make sure they matched genetically so that rejection wouldn’t be a concern. On surgery day, Yarber was crying and nervous, but Morgan remembers being ecstatic; if the procedure was successful, they would make history.
During a four-hour laparoscopic surgery, gynecologist David Levine, removed Morgan’s left ovary and passed it on to Silber and his colleague, Roger Gosden of Weill Cornell Medical College. The left ovary was chosen because it allowed easier surgical exposure. Silber and Gosden removed the ovary’s outer tissue, which is rich in egg-producing follicles, and through a small incision, sutured the tissue strip to Yarber’s old ovaries; surplus ovary tissue was frozen for later use. As blood flowed through the new transplanted tissue, hormones returned to regulate ovarian functions, and Yarber’s period came back in July 2004 but only for a day. Her second period came in September, and one month later, on Oct. 5, Yarber found out she was pregnant. The pregnancy occurred naturally, without using any fertility medications.
Yarber delivered a healthy baby girl, Anna Grace, on June 6, 2005.
After the transplant, Yarber had inconsistent ovulations from July 2004 to December 2006. Three years after the surgery, Yarber’s transplanted ovary ran out of eggs. Last month, the surplus ovarian tissue that was frozen after the first procedure was thawed and transplanted back to Yarber. The two surgeries were quite similar, but an additional adhesive was added to the tissue during the second surgery to generate blood flow sooner, preventing egg loss.
“I’m very hopeful and confident that God would bless us with another child,” Yarber says. “The surgery has been proven once, so we’re just waiting.” As the technique has improved, her second ovary transplant should last longer, but she is prepared to go back for more surgeries if it’s necessary. Yarber still has enough tissue frozen for two more transplants and hopes to have two or three more children. She is also thinking about writing a book with Morgan about their experience.
A developing technique
Since April 2004, Silber has performed eight successful ovary transplants between identical twins, and in February, he performed a successful ovary transplant with non-identical sisters sharing the same biological mother and father. Of the nine transplants, two have been of entire ovaries.
Danny Schust, associate professor at MU’s School of Medicine, says ovary transplants are a major but still experimental technique. “That’s going to be a fairly rare situation where you happen to have somebody who’s a match for an ovarian transplant,” Schust says. “In the future, if you’ve got an ovarian tissue bank, then people could go to that and try to match themselves, and I think that would be a possibility.” He thinks ovary transplants could become common within 10 years.
Ovarian transplants are not a major focus for local doctors, but some are currently taking ovaries out of cancer patients and freezing them, so that there’s a possibility of transplanting part of them back and restoring fertility after chemotherapy or radiation.
Three years have passed, but Yarber and Morgan, who received a lot of media attention for undergoing the first successful ovary transplant in the U.S., still have people come up to them in public and ask them questions about the surgery. The twins find it a blessing to be able to share their experience.
“Knowledge is power,” Yarber says. “If you don’t know there’s a treatment out there, then what do you do? I think it’s important that women know that there’s such an option out there.”
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