When Joy Lagos learned she had cancer, she had enough hope to believe she would beat it.
What brought the San Francisco resident to tears, however, was knowing that radiation and chemotherapy would lead to early menopause and rob her of the chance to have children.
Last week, that changed.
A renowned infertility expert in suburban St. Louis transplanted a whole ovary from Lagos' sister into Lagos, a step that could enable her to have children. Dr. Sherman Silber completed the whole ovary transplant Feb. 5 in Missouri, after performing the same procedure between twins last month.
The surgery could restore normal hormone function for women going through early menopause. It also could mean that one day a woman with cancer could freeze an ovary, undergo chemotherapy and radiation, and have her own ovary returned later to restore her fertility.
When Lagos, now 30, was diagnosed with non-Hodgkins lymphoma in 2004, her older sister Maeapple Chaney, now 31, donated bone marrow. Lagos was cured of cancer, but the treatment disabled her ovaries and she went into early menopause.
"I was devastated," Lagos recalled, her voice still breaking as she tried to talk about it Monday. Now married, Lagos wasn't with a partner at the time, so wasn't able to freeze any embryos, she said.
"I think it sounds selfish, but I just wanted to feel like a woman again," she said.
Yes, she wanted to have children of her own, but the menopause also induced osteoporosis, ended her monthly cycle, diminished her sex drive, and interfered with the natural "ebb and flow" of her emotions, she said.
Surgery on twins
Chaney was willing to donate eggs so Lagos and her new husband, Rodrigo Lagos, could have a baby through in vitro fertilization, but then Rodrigo Lagos saw a television report about Silber.
In 2004, Silber placed strips of ovarian tissue from a fertile twin into her prematurely menopausal sister. That woman, Stephanie Yarber, now has two children following the surgery. He has since done similar surgeries on six other sets of twins.
All of the twins who have had the ovarian tissue transplants are ovulating and menstruating normally, Silber said. But the women may get only a few years of ovarian function using the strips of tissue, he said.
Silber, who directs the Infertility Center of St. Louis at St. Luke's Hospital in Chesterfield, Mo., hopes that a whole ovary with its own blood supply will last decades.
Last week, Silber removed one of Chaney's ovaries and gave it to Lagos, a form of microsurgery that requires sewing the tiny ovarian artery of the donor to the ovarian artery of the recipient.
"It's maybe the size of a tiny piece of white thread you might use to sew on a button," Silber said of the vessel.
Dr. Pasquale Patrizio, director of the fertility center at Yale University, said he's paying attention to Silber's work because he is working on freezing and thawing ovaries to help cancer patients preserve their fertility. "It'll tell us in the field if the entire organ can be successfully retransplanted," Patrizio said.
Close match required
Surgeons at China's Zhejiang Medical Science University reported a successful whole ovary transplant between sisters earlier this decade; however, Silber and Patrizio said they have not seen any published medical literature or peer review related to that case.
Doctors also still have concerns about transplants that would require immune-suppressing drugs because of possible health effects for the mothers and their babies. "If they're not a close match, we're not ready to tackle that yet," Silber said.
Because of the bone marrow transplant and the close match to Chaney, Lagos is able to tolerate her sister's tissue and didn't have to use the drugs.
The Lagoses said the surgery cost about $15,000, which is being paid for with the couple's resources and donations. Chaney, who lives on Vandenberg Air Force Base in Lompoc, Calif., said it's possible she could go into menopause a few years earlier than she otherwise would have because of the ovary donation, but doesn't regret the bone marrow and ovary she has given her sister.
"It's a great opportunity, both for my sister and for fertility treatment in general," Chaney said.