ST. LOUIS, June 7-A 24-year old woman treated with an ovarian-tissue transplant for premature ovarian failure has delivered a healthy baby girl, researchers here reported today.

Sherman J. Silber, M.D., of St. Luke's Hospital and colleagues reported that the woman resumed normal menstrual cycles within three months of transplantation with ovarian tissue harvested from her monozygotic twin.

Serum levels of gonadotropin and estrogen had returned to levels characteristic of those in young, fertile women. Endometrial thickness also reached preovulatory dimensions at this time, and an LH surge and elevated basal body temperature indicated that ovulation had occurred. The patient conceived naturally during this cycle.

"During the second cycle, she conceived, and her pregnancy progressed uneventfully," the authors wrote in a New England Journal of Medicine brief report that was released online today. It will be published in the July 7 print issue.

"This, to our knowledge, is the first case of transplantation of ovarian tissue from one person to another resulting in a birth," said the editors of the NEJM in explaining their decision to release the study early.

The donor underwent laparoscopic removal of her left ovary under general anesthesia. The ovarian cortical tissue was trimmed to a thickness of 1 to 2 mm.

The recipient underwent a minilaparotomy through a 3.5-cm incision above the pubis. The cortex of each streak ovary was resected, exposing the entire raw surface of the medulla. A section of approximately one third of the donor ovarian cortex was laid over the medulla of each ovary in the recipient and sutured onto the medulla.

The ovarian cortical tissue transplant followed an unsuccessful attempt at egg donation therapy using an egg donated by the fertile twin.

The transplant recipient was diagnosed with premature ovarian failure at age 14 and for the 10 years prior to the transplant she had no menses. When she was 20 years old, a laparoscopic examination and ovarian biopsy revealed atrophic, elongated ("streak") gonads with no follicles and a small uterus with an otherwise normal reproductive tract.

"The pregnancy was established spontaneously, without ancillary assistance," the authors wrote. They noted that they chose grafting of ovarian cortex because it "is minimally invasive and involved substantially less risk."

They concluded that even though grafting between monozygotic twins will be rare, this case demonstrates that the successful "ovarian function can be restored and that natural conception can be achieved after transplantation of ovarian tissue." This suggests that young women who are sterilized as the result of cancer treatments may have fertility restored with ovarian transplantation.

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