When Vali Creus was told she had ovarian cancer at age 19, doctors promptly removed her left ovary. Five years later, more tumours were discovered, and they removed her other one.
The surgeries saved Vali’s life but also sent her into early and destroyed her hopes of conceiving a child.
The Melbourne-based woman, now 41, always wanted children, but her medical team needed to act quickly.
“They weren’t willing to wait for me to try and . Their main concern was getting me healthy,” Vali told SBS News.
Vali was fortunate to have gynaecological oncologist Tom Jobling as her surgeon at Epworth Freemasons hospital in Melbourne. He had the foresight to remove some ovarian tissue ahead of her second surgery.
Jobling was aware of research underway to develop an ovarian grafting technique by Kate Stern, obstetric professor of obstetrics and gynaecology at the University of Melbourne and head of clinical research at Melbourne IVF.
The procedure involved removing a tiny amount of ovarian tissue, which contains tens of thousands of eggs, and freezing it for the future. Once reimplanted, the tissue is able to produce hormones and grow the eggs.
With Vali, the procedure would be experimental — she had no ovaries in which to reimplant the tissues and her pelvis was damaged from surgery.
But a few years later, when Vali was 32 and had been dating her partner Dean* for four years, she decided to take the long shot.
Stern’s team thawed her ovarian tissue and, in a world-first operation, implanted it into her abdominal wall.
Since she was a young girl, Vali Creus had always wanted to have children but she had no idea about the fertility challenges that lay ahead of her. Source: Supplied
Early signs were promising — the tissue managed to create its own blood supply and develop follicles, allowing eggs to grow.
After 17 rounds of IVF over about three years, Vali and Dean’s six-week scan revealed incredible images: two developing embryos.
“We were all crying, and they called Kate (Stern) and she was crying,” Vali said.
“And that was just the first little black hole that they saw on the screen. Then [the sonographer] moved the probe and there was another one. So I think I was just in shock.
“I didn’t think I would ever have kids … I’m the luckiest unlucky person you’ll know.”
Vali Creus says it was “a shock” to discover that she was carrying twins after an experimental fertility procedure and 17 rounds of IVF. Source: Supplied
An ‘extraordinary’ process, but with challenges and risks
Stern told SBS News it was “very exciting being able to help Vali have her children” and to prove the viability of the procedure.
“This was a woman who had had her ovaries removed. So this absolutely conclusively, perhaps for the first time … proves that you can take some ovarian tissue, you can put it back maybe anywhere, and it will start getting a blood supply and making eggs,” she said.
“It’s quite extraordinary.”
Alexis and Kaia are now 10 years old and say they’re happy their mum Vali Creus was so determined to have children. Source: Supplied
Stern said ovarian tissue freezing had given hope to thousands of women at high risk of losing their fertility because of cancer treatment.
But she warned the , as it was for Vali.
“She worked so hard, it took a lot of time. This is not a one-hit wonder.”
Stern now hopes to take the process a step further and use ovarian grafts to grow viable eggs outside the body in a lab setting.
This groundbreaking procedure could provide a path to parenthood for those with ovarian cancer or haematological cancers like leukaemia or lymphoma that are bloodborne and for whom transplantation carries a risk of the cancer reappearing.
It might also assist women who have had surgery, such as radiation to their pelvis or for , for whom tissue reimplantation may be difficult or risky.
“We would like to [use this procedure] to get more potential for our patients from their ovarian tissue,” Stern said.
“If achieved, it could create hundreds of eggs over a relatively brief space of time.”
But growing from tiny immature eggs outside the body isn’t easy. Stern’s team is currently working to develop the technique with research partners overseas.
“I hope that somewhere between the next two and five years, the fertility scientific community will have nailed this,” she said.
The possibility of delaying menopause
While using ovarian grafts is now well-established for cancer patients, scientists still debate using the procedure with healthy people.
Yale University’s Professor Kutluk Oktay is another industry pioneer. The reproductive endocrinologist and ovarian biologist has led a study modelling how ovarian tissue transplants could stave off menopause for decades.
This could enable women to delay its troublesome side effects and have children naturally later in life.
“Menopause is part of ageing … it’s not a condition, but when it happens, it brings with it many problems for a lot of women,” Oktay told SBS News.
He said the 11 per cent of women who experience late menopause — after the age of 55 — enjoy health benefits including less bone loss, cardiovascular diseases, dementia, anxiety and depression.
“Our current position is that if there’s a way to delay menopause to the upper limit of normal range, then I think women would benefit from this,” he said.
“A lot of ageing processes are accelerated after menopause. So in a way, delaying menopause could be an indirect approach to slowing down ageing.”
According to his modelling, tissue preserved from a 40-year-old would delay menopause by a median of 3.4 years if it was reimplanted right before menopause. Tissue frozen from a 21-year-old could delay it by 19.4 years.
The assumptions are based on just one transplant. But this delay could be further extended — potentially by decades — with multiple tissue replacements, each just before menopause.
She worked so hard, it took a lot of time. This is not a one-hit wonder.
Kate Stern
Oktay said his team would continue to collect data, but believed enough was already known to justify freezing tissue.
Though he added that every case was individual.
“We’re not looking at allowing or enabling women to have children in unsafe ages. That’s not the purpose of the procedure. In the end, all these risks and benefits are explained to the patient and the final decision is the woman’s to make,” he added.
Stern believes the potential benefits of delaying menopause through ovarian grafting don’t yet outweigh the risks.
“Just because we can do something technically, doesn’t mean we should,” she said.
“The bigger question of whether it’s safe and the right thing to do to preserve female hormones well into their sixties is not answered yet, because the risks of breast cancer and other cancers may be increased by that increased oestrogen.
“I’m not discounting the possibility, but I would like to see more research into the safety of preserving reproductive hormones in the long term.”
Stern is against offering ovarian grafting for patients who are not commencing toxic treatment that could damage the ovaries. She does not advise it be used as an alternative to freezing eggs, in order to preserve fertility for healthy patients.
“The removal of the tissue can potentially cause damage to the ovaries and it does reduce the number of eggs available for spontaneous ovulation and reproductive function … [so] you might be actually taking away some of that woman’s fertility potential,” she said.
Beyond this, there are no guarantees ovarian grafting would work, she said.
“For most women, the risk-benefit analysis of taking tissue when you don’t have any specific risk to your fertility is not in favour,” she said.
A world of possibility
Nevertheless, Stern believes that preserving fertility for young cancer patients provides a learning opportunity when it comes to reproductive ageing.
“The more we learn about how to develop mature eggs from immature eggs to help women get pregnant, the more we are going to understand about fertility in general and how to preserve reproductive health for the future,” she said.
“It’s so exciting.”
Vali Creus (top left) and her husband Dean* underwent 17 rounds of IVF and a then-experimental procedure to be able to have their daughters. Source: Supplied
Vali was so grateful to Stern and her team that she gave one of her twin daughters the middle name Kate.
Alexis and Kaia are now 10, and after one more round of surgery and a hysterectomy, Vali has remained cancer-free for years.
“Now that I have the girls, it means more to me that I’m around to see them grow up,” she said.
“That’s the beauty of medical science. We’re just working out ways to help women or people in general just live longer, stronger, better lives.”
This article was produced in collaboration with the Australian Science Media Centre and supported by a META Public Interest Journalism Fund administered by the Walkley Foundation.
