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January 23, 2014 | Posted By Lisa Campo-Engelstein, PhD
When we think about organ transplantation, the organs that usually come to mind are the heart, or possibly the kidney, the most commonly transplanted organ. Transplantations are generally regarded as necessary to the life of the person receiving the transplant or to physiologically improving that life: the transplant is seen as making the recipient “whole” once more. The idea of wholeness that a transplant renders can extend beyond the physiological to the individual, the familial, and the cultural; this can be seen dramatically in the case of ovarian transplantation. The donor ovary, and with it the potential of restored fertility and the hope of pregnancy and thus motherhood, is a surgical means to make her whole.

Stephanie Yarber entered menopause for no apparent reason at age 14. Her identical twin sister, Melanie Morgan, maintained her fertility and donated eggs to Yarber. However, after at least two failed IVF cycles in her early 20s,Yarber was broke. Through her research on infertility treatment, she stumbled across Dr. Sherman Silber’s work on testicle transplants and discovered that his practice focused on infertility problems in both men and women. Thinking that a similar gonadal transplant could be possible in women, Yarber called Silber to ask if he thought an ovary transplant was “a crazy idea.” Silber, who had been considering the possibility of an ovarian transplant since the testicle transplant, jumped at the opportunity to try this procedure, telling Yarber “I’ve been waiting for your call for 30 years.”

Morgan donated one of her ovaries to her sister, and the doctor grafted a piece of ovarian tissue onto Yarber’s ovary; the remaining pieces of ovarian tissue were cryopreserved. Eight days later, Yarber had her first menstrual cycle in 10 years, and one month later she was pregnant; she delivered a healthy baby in June 2005. After the birth of her daughter, Yarber resumed menses and conceived naturally again. However, this pregnancy ended in a miscarriage. Three years after the ovarian tissue transplant, Yarber reentered menopause. Per her request, some of the cryopreserved tissue was transplanted to Yarber’s ovary, and she conceived approximately five months later and delivered another girl.

Yarber has received significant media coverage as the first successful ovarian tissue transplantation. She has welcomed this coverage because she hopes it will alert other women to the possibility of ovarian tissue transplant as a way of addressing their infertility problems. Since Yarber’s initial case, Silber has performed ovarian tissue transplantation for six other cases (and one full ovary transplant) in which one identical twin suffers from premature ovarian failure while the other remains fertile. From these seven cases, there have been seven pregnancies, two miscarriages, and five live births.

Women are increasingly willing to undergo invasive treatments, including various surgeries, to correct an impairment of their bodies in order to provide them with a chance for motherhood. The convergence of motherhood as defining femininity with the increasing reliance on physicians to treat involuntarily childless women enabled a perception that infertility was a problem of and with the female body. Thus, women who sought treatment sought the restoration not just of their reproductive functions, but also of their feminine identity. This is clearly the case with Yarber, as she came up with the idea of ovarian transplant, sought out physicians to inquire about its possibility, was willing to undergo it as an experimental surgery, and did so in an effort to have transplantation return herself to wholeness, which she identified as the possibility of motherhood through pregnancy.

Transplantation of any organ, be it a heart, kidney, liver, or ovary, has been seen as transforming ideas about a body, with recipients feeling that they are receiving not just a body part but also a part of the donor’s identity. Additionally, some have seen organ transplantation as transgressing taboos against violating bodily identity and conventional boundaries between bodies. The donation of ovarian tissue adds another layer to these conceptions of organ donation by adding the potential of reproduction to these ideas about bodily identity. That Yarber was willing to undergo an experimental surgery even though she was not in physical need of the transplant in order to live underscores the emotional pain—and social fears—of infertility. The transplanted tissue from another woman’s body rendered her whole, which, for Yarber, meant the possibility of motherhood via pregnancy.

For citations and more on this topic, see Rodriguez, S. and L. Campo-Engelstein. “Conceiving Wholeness: Women, Motherhood, and Ovarian Transplantation, 1901 and 2004.” Perspectives in Biology and Medicine 54.3 (Summer 2011). http://www.ncbi.nlm.nih.gov/pubmed/21857130.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.
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BIOETHICS TODAY is the blog of the Alden March Bioethics Institute, presenting topical and timely commentary on issues, trends, and breaking news in the broad arena of bioethics. BIOETHICS TODAY presents interviews, opinion pieces, and ongoing articles on health care policy, end-of-life decision making, emerging issues in genetics and genomics, procreative liberty and reproductive health, ethics in clinical trials, medicine and the media, distributive justice and health care delivery in developing nations, and the intersection of environmental conservation and bioethics.
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