ISGE VIDEOS

Tamer Seckin:  Hi, this is Dr. Seckin.  We are reporting from Osaka, Japan.  I am very excited to introduce you to our speaker, Professor Jack Donnez, among many things in the world that he is credited.  But the least I can tell how much of an impact his news hit two years ago.

 

Jacques Donnez:  Published.

 

Tamer Seckin:  The first live pregnancy by ovarian transplantation and we have just witnessed an incredible presentation with him.  So far, how many ovarian tissues have you put in the freezer?

 

Jacques Donnez:  More than 250, in the majority of cases plus patients with malignant disease, but we have also a few patients with familiar history of premature ovarian menopause of women with severe endometriosis recurrence cyst.  But the majority of cases are patients with Hodgkin complications.

 

Tamer Seckin:  And how many of these ovaries you have put back as transplanted?

 

Jacques Donnez:  So far I have performed seven cases of reimplantation in five different women.  It means that in two patients are implanted twice.

 

Tamer Seckin:  And I know we have one pregnancies and how the child born and any other upcoming pregnancies from your series?

 

Jacques Donnez:  From my series, no; I hope every months but you should know that even if we start the preservation in 1996, we should keep in mind that we have to wait at least five years before proposal of the implantation we have to be sure that the patient is cured from the disease.  Then very frequently she has to meet a partner and only that will desire to get pregnant.  So that in fact, we have not a long followup of the last cases and but there is women who have followed weekly, every month and we can observe the development of matured follicles for about 2 cm.  We can hear the patient experience, menstrual bleeding, and so far we have a single pregnancy in our department.

 

Tamer Seckin:  I am exceptionally excited personally of this percentage because I have been trying to track you to catch one of these things that you were talking about the subject for the last two years, since simply because I was present in the first ovarian implantation while done by Dr. Oktay and he is very junior to me yet good friend at that time and I was the second surgeon in waiting, if there was a problem for the transplantation and I have also given him significant amount of tissues stripped ovary.  I have seen that from your technique there must be something with your endoscopic surgery background that made you the first person, who was successful to have a successful pregnancy outcome.  Do you agree with my comment because this is an Endoscopic Surgery Conference and I think we should underline that?

 

Jacques Donnez:  Yeah, for sure that the experience in endoscopic surgery gave me a good idea, good opportunity to do that and to do that by endoscopy and it’s not very difficult.  It requires some experience, but it’s like finally since you just opened the ovary, removed the cortex, have an access to the medulla and put a small piece on the medulla.

 

Tamer Seckin:  You did target the right area on the body to put first of all because I think in my opinion the area where you put these fragments are very important.  Another thing that I have witnessed at your, you make your specimen very small and what is the reason for that.

 

Jacques Donnez:  I agree with your comment and the last two case I showed you the fragments were very small.  But they were cryopreserved in 2000 and at that time, we were convinced that the fragment should be very small for the cryoprotective effect of the _ and so far we are not convinced at all and the best size its like the _ where the fragment were above a little bit more than 1 cm and 3, 4, 5 mm wide.  That is the ideal because it allows you to stitch the fragment to the medulla.  With the small fragment, it’s impossible to suture them to the medulla, you have to put on the medulla and cover by Interceed, which was not the ideal form, not the ideal procedure, but it works, it works.  But I think that so far now what we recommend in 2007 is to remove piece of the ovarian cortex and it will be more than 1 cm from 3, 4, 5 cm wide.

 

Tamer Seckin:  One thing that it was very interesting for me to learn from your lecture was and for all of our viewers when you transplanted the tissue, the functions of the ovary does not kickback for a while, would you tell our viewers why, how long does it take?

 

Jacques Donnez:  Finally it takes about five months before the first peak of oestradiol why because the primordial follicles which are the only follicles which survive to the cryopreservation.  All the other follicles primary, secondary, tertiary follicles died from the cryopreservation.  That is only the primordial follicle survive and it takes a little bit more than four months before a primordial follicle can reach the stage of antral follicles, matured follicles.  This is completely consistent with the natural physiology of the ovary.

 

Tamer Seckin:  For the viewers, I must say that Dr. Donnez’s Department has a emergency action plan for patients who are diagnosed with any cancer that requires immediate ovarian care and they can schedule a patient within 24 hours before the chemotherapy is initiated.  I think that is very impressive.  And lastly I know you are very tired, you were just in Osaka from a long plane trip, but for the women who could accidentally hit our ISGE website, there are things that we must be able to tell them what the female reproduction is looking ahead in the years ahead.  We are a little bit morally and ethically obviously squeezed in cancer indications like now we are limited, but I am sure you will be able to say things about life after menopause to children and ovarian functions, estrogen where are we going with this ovarian cortex preservation.

 

Jacques Donnez:  This is very, very important question with many ethical issues.  I think that first we should keep in mind that if we cryopreserve ovarian tissue, you should do the cryopreservation of tissue before the patient hits 35 years.  After that, the ovarian reserve is same, not very low, but lower than at the age of 20, and, we know that we will lose about 60 to 80% of the follicles.  So that the risk that it does not work anymore.  But for example, in the future I am quite sure that a woman for example of 22 years, will plan to have a baby at the age of 25 because of professional reason or for other reasons.  You can imagine that she will ask us to cryopreserve her ovary on one side.  With the ovary from the other side, she will be able maybe to get to be pregnant at the age of 32, 33.  If not, she has still in the freezer an ovary, with an intact ovarian reserve which can be reimplanted with its vascular pedicle with a high chance of success.  So one part of your question is for the post-menopausal woman, natural menopausal and for sure, if a patient have cryopreserved ovarian tissue in the fridge, we can restore by implantation the ovarian function.  From a medical point of view, there is a big difference between allowing to have an ovarian function and allowing to have a baby, and in my Department in fact, we do not accept IVF, reimplantation, egg donation after the age of 43 years.  So that, personally I am not in favor of babies in postmenopausal women because I think to the young boy of the young girl, but these is a difference between the restoration of ovarian function and the pregnancy.  But all cases I have performed so far reimplantation are women less than 42, that it’s a little big, the logic of issue that we have in the department even for IVF, egg donation is 42.  I’m not sure that I’m correct or not, but it is a little bit ethical issue we have.

 

Tamer Seckin:  In the age of robotics, in the age of mini-cameras traveling in our body, I think the human body is so resilient survives the instinct of survival even in egg formation and thanks for the guys like you who can make it.

 

Jacques Donnez:  Thank you Tamer.