Fertility and Turner’s syndrome

Dear Professor Winston,
My query concerns ovary transplants.
My daughter, aged 26, has Turner’s Syndrome. She has a uterus, was born with small ovaries and now takes HRT as she effectively has no eggs remaining, but has been told she could have IVF.
I hear reports of ovary transplants in women who have had cancer treatment, resulting in recommencing periods and possibly being able to have a child. Are there “ovary banks” for transplantation which could lead to menstruating again, feeling more feminine, leading to improved fertility? She has told me that this is the most important thing in her life. I write on her behalf.
Many thanks,

Dear S,

I am sorry to hear about your daughter, but I have to say the outlook for what you ask is not good.

An ovarian transplant, or a transplant of ovarian tissue, may stave off the undesirable effects of being ‘menopausal’ but hormone replacement therapy is likely to be much easier, somewhat safer and much more likely to be effective. There are no ovarian banks that I know of.

Theoretically, an ovarian tissue transplant just might result in a successful pregnancy but it is most unlikely in somebody with Turner’s syndrome. There has been one successful live birth after transplantation in a woman with Turner’s syndrome. This was in Belgium in 2011 but this patient had a healthy identical twin who was prepared to be a donor. Being an identical twin meant there was no risk of tissue rejection.

Up to about 10% of young women with Turner’s may have enough follicles to result in a successful pregnancy with or without IVF, and egg donation is also possible in some cases. About half of all pregnancies are likely to result in miscarriage and pregnancy, if successful, is more dangerous as many (if not most) pregnancies in women with Turner’s syndrome are likely to have high blood pressure during pregnancy; moreover, liver function may also be impaired. Pregnancy is more dangerous if there is any congenital abnormalities of major blood vessels in the chest or heart.

It is true that some physicians are advocating freezing ovarian tissue from younger women with Downs before ovarian failure occurs with cessation of periods and total loss of all remaining eggs. The idea is that this this tissue might then be transplanted back at a later stage to produce pregnancy. As far as I know, this strategy has not been successful.

I hope this is helpful
Robert Winston