Q&A: What is ovarian grafting?

Grafting is a process where tissue of some type is implanted or attached surgically to other tissue. You may have heard of skin grafting for burns and other injuries. The process can be done with tissue from the ovaries as well.

Research and advances in understanding infertility have broadened the scope of treatments and methods for dealing with roadblocks to conception. Ovarian grafting may be attempted in situations like infertility or possible early menopause due to chemotherapy. In some cases when a woman is diagnosed with cancer, her healthy ovary or ovarian tissue may be removed before she begins chemotherapy or radiation treatments so that it can be frozen and used in the future after chemotherapy treatment has concluded.

With ovarian grafting there are two methods for two different scenarios:

• Ovarian tissue may be transplanted from a healthy ovary and attached to an ovary that is not functioning properly. (The idea here is that the healthy ovarian tissue will help to regenerate the otherwise unhealthy tissue, but it can only work with donor tissue with a perfect match—like a twin sister.)
• An ovary be removed prior to chemotherapy or radiation, frozen for storage, and then reimplanted into the woman's own body.

In the case of a woman who has undergone chemotherapy, is now healthy, and is ready to attempt getting pregnant, the ovary or tissue can then be grafted (implanted) into her pelvis or in some cases into the antecubital fossa (where your arm bends). The ovary is placed into her arm after her chemotheraypy or radiation is complete. She then receives medication to help her hormone levels kick the ovary back into production. Through ultrasound monitoring, the eggs can be seen and then removed for in vitro use.

Implanting the ovary back into the pelvis can be more invasive than placing it into the arm. Many doctors will opt for placing the ovary in the arm because it may be easier to watch for egg production via ultrasound.

Once the ovary or ovarian tissue is reimplanted, the woman will receive fertility treatments to help cause ovulation. In some cases normal hormone levels and ovulation and menstruation returns. If she does successfully ovulate, the eggs are removed and in vitro fertilization (IVF) can be attempted. According to Dr. Nora Miller, MD, of Women's Fertility Center in Stamford, Connecticut, there have not been any births using the arm implantation process as of early 2009, but there have been a few with pelvic implantation.

According to researcher Dr. Roger Gosden, MD, of Cornell University, who published a paper on this topic in 2008, "Nearly 100 centers in the US are offering ovarian tissue banking for cancer patients on an experimental basis, and a few thousand specimens have been banked worldwide." Fertilehope.org is one of the many websites available for women looking for information and guidance in this situation. Talk with your doctor about what might be the best option for you.