One of the world’s leading expert in fertility preservation, Kutluk Oktay, MD, PhD, an Attending Physician at NYU Winthrop Hospital and the Director of the Ovarian Transplant Program, performed Long Island’s first-ever ovarian transplant. The procedure is giving new hope to the 26-year-old leukemia survivor that she might someday bear children.
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Precision procedure
The procedure replaced ovarian tissue that had been surgically removed from her at age 15, prior to radiation therapy for a bone marrow transplant.
Oktay pioneered ovarian transplants in 1999, but there remain only a dozen or so experts in the world versed in such transplants. Oktay achieved another innovation with the NYU Winthrop procedure, utilizing the Da Vinci robot to assist with the surgery, thereby optimizing both the precision of the procedure and likelihood of a successful patient outcome.
“The ovarian transplant … should be presented as a medical option for any young girl or woman who risks losing her fertility due to chemotherapy or radiation treatments,” Oktay, explained.
“An ovarian transplant should be viewed in disciplines such as oncology as preventative care, since the procedure can prevent the loss of fertility. Diseases such as cancer are devastating enough when occurring in children, let alone when a family is faced with the prospects of their girl never having the chance to bear her own children.”
Photo 1.0: Kutluk Oktay, MD, PhD (center), the world’s leader in fertility preservation, discusses the role of the Da Vinci robot in an ovarian transplant procedure.How it works
Oktay, who is also a Professor of Obstetrics, Gynecology and Reproductive Sciences at Yale University School of Medicine, noted that the removal of a girl’s ovary is a simple procedure that can be done at any age. He has performed the procedure on children as young as one year of age. In the ovarian tissue harvesting procedure, one ovary is removed, and slivers of the ovarian tissue are preserved with a cryoprotective agent and then frozen with an automated machine. The tissue is then stored at a temperature of minus 270 degrees Celsius (about minus 518 degrees Fahrenheit), with no time limit for storage. Later, following remission of cancer, the tissue can be transplanted back into a woman to restore fertility. In that procedure, approximately 15 to 20 slivers of ovarian tissue are thawed and grafted on to the woman’s remaining ovary, with that transplanted tissue connected to existing ovary blood vessels.
“The existing ovary serves as a type of dock, opening up a vascular platform where the thawed tissue can be attached,” added Oktay. “The robotic arms then assist the surgeon in suturing and rejoining old and new tissue together, creating a new hybrid ovary.”
In addition, Oktay developed a modified procedure for patients who cannot tolerate surgery, which involves grafting the ovarian tissue under the abdominal skin.
The NYU Winthrop patient involved in the latest procedure suffered from leukemia three times as a child, at ages three, eight and then 15. In the last instance, she had to be induced into a month-long coma as cancer cells swelled her brain. Prior to beginning radiation treatments for a bone marrow transplant, the girl’s parents reached out to Oktay, and 72 hours later, she underwent an ovary removal.
“This procedure is literally life-changing. I now have the chance to have my own children.” noted the patients, who prefers to remain anonymous at this time but, now married, is looking forward to starting a family.
It will take three to six months before the success of the patient’s transplant will be fully determined, though initial follow-up showed great promise with strong blood flow from the new vascular platform into the new ovary upon radiological examination.
The promisse
Rosaria Ruttenber, age 39, knows well the promise of this procedure. The Norwalk, CT resident had suffered from Hodgkin’s disease, a cancer of the lymphatic tissue. Before undergoing a stem cell transplant at age 23, Oktay removed one of her ovaries and cryopreserved it. Sixteen years later, Oktay transplanted her ovarian tissue.
The transplant was a success and her daughter, Giuliana was born in 2015. The family now hopes to have another child in the near future.
Last Editorial Review: November 27, 2017
Featured Image: Doctor talking to a Cancer Patient. Courtesy: ? Fotolia | Used with permission. Photo 1.0: Kutluk Oktay, MD, PhD (center), the world’s leader in fertility preservation, discusses the role of the Da Vinci robot in an ovarian transplant procedure. Courtesy: NYU Winthrop Hospital | Used with Permssion.
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