Hope for cancer patients who want babies

SINGAPORE - Doctors at Singapore General Hospital (SGH) have, for the first time here, used a breakthrough method that preserves the ovary of a woman while she undergoes chemotherapy treatment.

The procedure involves extracting one ovary, then slicing it into smaller pieces and keeping the tissue frozen for up to a few years, and finally transplanting the tissue back into the patient's body.

Dr Yu Su Ling, director of SGH's Centre for Assisted Reproduction (Care), said medical advances have led to higher survival rates among cancer patients.

However, the treatment to quell the disease often leads to early menopause, ovarian failure and an inability to have children.

The new procedure has turned the situation around, as the first patient to undergo it here has found out.

The 40-year-old breast cancer survivor was already entering menopause when her ovary was replanted. Soon after, her menstruation resumed, and now, she should be able to conceive.

The customer service officer, who wanted to be known only as Madam Tan, said she is "very happy to be back to normal".

"If possible, I intend to have children - and I want to do it naturally," said the childless Madam Tan, who has been married for five years.

She was 37 when she was diagnosed with cancer, and decided to give orthotopic ovarian transplantation a go after her doctor suggested it.

In 2010, her ovary was extracted and stored before chemotherapy treatment was started.

Twelve other women at SGH, aged between 19 and 40, have had their ovaries taken out and kept in deep freeze.

The extraction is done using keyhole surgery, a minimally invasive technique where surgical instruments are inserted through small incisions in the body.

The ovary is cut into thin strips no thicker than 1mm each. This way, blood vessels can re-form quickly after the transplant, said Dr Yu.

The strips are super-cooled, using liquid nitrogen, to about minus 200 deg C and stored.

The patient then goes for treatment and after she is free of the disease - usually at least two years later - the slices are inserted back into the remaining ovary, which would most likely be dead from the cancer treatment.

Madam Tan had breast cancer, but this procedure can help women with other forms of cancer too, said Dr Yu.

The cost, including surgery and storage of the ovarian tissue, is between $7,400 and $13,500.

Orthotopic ovarian transplantation was deemed an experimental procedure until a few years ago.

The first successful case was reported in 2000 in the United States. In 2004, a woman in Belgium gave birth after undergoing the procedure. Since then, about 20 women worldwide have managed to have babies this way.

Associate Professor Tan Hak Koon, who heads SGH's obstetrics and gynaecology department, said this option offers great hope for younger and single women.

It can be devastating for young women in the "prime of their life" to lose their fertility and go through menopause, he said.


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