At 27 years, Soumya (name changed) had to undergo removal of the uterus and the left ovary, due to uterine cancer (mild-grade endometrioid adenocarcinoma). Her surgical oncologist decided to preserve her right ovary, but moved it to the abdominal wall, just underneath the skin.
Five years later, the woman became a mother through surrogacy as fertility specialists, in a novel method, extracted the egg from the transpositioned ovary percutaneously, and fertilised it.
Soumya’s case was unique as IVF specialists at GG Fertility and Women’s Speciality Hospital found no reports of pregnancies in which eggs were extracted from an ovary in such an ectopic location, and that too, retrieved through the skin, according to Priya Selvaraj, scientific and assistant director of the hospital.
“Her uterus with fallopian tubes as well as the left ovary were removed in a hospital in Kerala. What was remaining was her right ovary. The only way she could have her child was through surrogacy. There was a twist as the right ovary along with its blood supply, instead of being lodged within the abdomen, was brought up through the abdominal wall and placed right beneath the skin,” she said.
Ovaries in cancer patients, she said, can be located within the abdomen or above the pelvic brim in case they had to go undergo radiation. In the literature search, the doctors found that people in this situation usually have their ovaries removed and later transplanted back once they are cancer free. In some cases, it it moved out of its normal position in the pelvic area to just above the pelvis, and eggs are retrieved laproscopically, she explained.
Being married and childless, the woman was referred to GG Hospital in August 2016. After detailed work-up, she was put on stimulant injections and doctors used a syringe (same as used in regular IVF procedures) to extract the eggs, but through the skin of the patient’s abdomen. The quality of eggs was another challenge, Dr. Selvaraj added.
Three attempts later, doctors finally managed to get embryos out of such a retrieval and implanted them a surrogate in 2018. She delivered a girl baby weighing 2.62 kg on February 16.
Doctors said this was the country’s first surrogate birth following egg extraction from an ovary transpositioned under the skin.
The hospital is now working to preserve ovarian tissue for future re-transplantation into the individual for fertility purpose after thawing. “Childhood cancers in pre/pubertal age group are maximum indicators for ovarian tissue preservation,” she added. Kamala Selvaraj, associate director of the hospital, was present.
Published - February 19, 2019 09:02 pm IST
