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Knight Ridder Newspapers
(KRT)
CANTON, Ohio - Ann Dauer's pregnancy is joyous news. And not just for the 33-year-old and her husband, Greg.
Her pregnancy - possibly the first or second of its kind in the world - represents hope for tens of thousands of women each year who face infertility from cancer treatment, as well as for women who plan to delay childbirth until their biological clocks are ticking the loudest.
Just three years ago, it seemed as if the day for birth announcements and baby showers would never come for the Dauers.
In March 2002, Dauer - then living in Buffalo, N.Y. - was diagnosed with non-Hodgkin's lymphoma, a cancer of the lymph nodes.
She had two choices. She could start chemotherapy and a bone-marrow transplant right away, which would cause ovarian failure, push her into early menopause and end the Dauers' plans for a family. Or she could delay treatment a couple of days so that one of her ovaries could be removed and frozen for future use.
She chose to have an ovary removed. Then in August 2004, after she was declared cancer-free, the ovary, which had been cut into strips, was thawed and reinserted into her lower abdomen, just under the skin.
The expectation was that within three months, the transplanted ovarian tissue would grow blood vessels and produce eggs, which it did.
"We started to feel little bumps under the skin," said Dauer, who now lives in Canton. "Those were the eggs."
The next step would have been to harvest the eggs, fertilize them with her husband's sperm and implant an embryo in Dauer's uterus, a procedure known as in-vitro fertilization.
"But before we could go down that road," she said, "we were pregnant."
Her remaining ovary, which had not been removed and had ceased to function, had come back to life, allowing her to become pregnant naturally.
Her doctors are calling it a miracle.
Only one other woman - who lived in Belgium - had become pregnant after an ovarian tissue transplant. But there have been questions about whether that woman experienced spontaneous recovery of ovarian function, which is known to happen, or whether her return from menopause was because of the implantation of ovarian tissue.
In fact, it's not clear how Dauer has reached this point, either.
Considering that she began to show signs of coming out of menopause within weeks of the tissue implantation, Dr. James R. Wilson, her Canton obstetrician/gynecologist, suspects that this wasn't a case of spontaneous return of ovarian function.
What snapped her body out of menopause, though, is open for debate, he said. It could be that the implanted ovarian tissue jump-started her remaining ovary to begin functioning again. Or it could be that stem cells in the bone-marrow transplant used to treat her lymphoma caused the ovary to produce new eggs.
A study earlier this summer showed that bone-marrow stem cells can restart failed ovaries in mice.
Dr. Kutluk Oktay, a world leader in ovarian tissue preservation at Cornell University's Weill Medical College, performed Dauer's tissue implantation. He could not be reached for comment.
In June, Oktay told the magazine The Scientist that the mouse study "is rock-solid evidence for the revolutionary concept that eggs can originate in bone marrow. The most important follow-up study now is to confirm whether these eggs can resolve in pregnancies."
In a letter to the New England Journal of Medicine, Oktay wrote that implanting frozen ovarian tissue "offers a new alternative for women who face ovarian failure due to surgery, chemotherapy or radiation therapy."
However, an article in the July 7 issue of the journal said that using ovarian implantation for women who have chosen to delay motherhood "is controversial and should be considered experimental."
There are also concerns that implanted ovarian tissue could inadvertently be carrying cancer cells, which could spread once implanted.
The procedure has not been tested in a large clinical trial.
A television crew from NBC's "Today" show was in Wilson's Canton office Wednesday as part of a series on infertility that is to air this week.
Before Dauer entered Wilson's office in late 2004, he had heard of this type of ovarian tissue transplantation only in passing. He certainly had never seen another patient like Dauer. Few doctors have.
"It was fascinating," he said. "Very fascinating."
Now, though, Dauer's is just a normal pregnancy, with all signs pointing to a healthy delivery on Sept. 17.
The repercussions of her pregnancy, however, will be anything but normal. "It really opens a door of opportunity for young gals who get a diagnosis of cancer but still hope to have a family someday," Wilson said.
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(c) 2005, Akron Beacon Journal (Akron, Ohio). Distributed by Knight Ridder/Tribune News Service.
