Four little miracles

(JNS) — Seven months ago, following years of aggressive cancer treatment for Hodgkin lymphoma, Ayelet Rosenberg, 35, gave birth to her fourth child, Yishai, making history as the first woman in the world to give birth to four children through cryopreservation of her eggs.

The successful treatment was made possible by the innovative work of the Fertility Preservation Center at Sheba Medical Center in Ramat Gan.

The experimental method performed by Prof. Dror Meirow, head of the center, involved removing fetal eggs from Rosenberg’s ovaries, cryopreserving them, and then transferring them to her uterus as embryos to facilitate pregnancy following the successful conclusion of her cancer treatment.

In 2008, 21-year-old Rosenberg from Petach Tikva, religious and single, was diagnosed with Hodgkin lymphoma. Rosenberg told JNS that one of her doctors at the time said she should be grateful that she had “one of the easiest cancers.” That did not turn out to be quite the case.

When she was first diagnosed, the malignancy was limited to her lymph nodes and doctors indicated that a light chemotherapy regimen combined with radiotherapy would provide a cure and her fertility would not be affected.

Soon after, however, the cancer spread to her liver, and a more aggressive therapeutic approach was ordered.

Rosenberg discovered that the treatment needed to save her life might indeed prevent her from conceiving, and Rosenberg decided to do everything possible to ensure this would not happen.

15 percent chance to conceive

“I was devastated when they told me there was an 85 percent chance I would not ever be able to conceive.

“You can’t begin to comprehend how difficult the idea of not being a mother is, but luckily I’ve met wonderful doctors who acted as God’s emissaries,” Rosenberg told JNS. “That was the one thing that really frightened me. More than the possibility of losing my hair or the isolation I would have to go through during the cancer treatment, the possibility I would not have a family was on my mind all the time.”

Rosenberg consulted many rabbis during this difficult period about how to proceed. Despite the pessimistic forecasts of doctors, she decided to explore every avenue possible.

In typical Israeli fashion, Rosenberg found Meirow through personal connections. A colleague of her mother had a daughter who had been treated by him and made the connection.

Meirow is a veteran in the field of cryopreservation research, having studied with the Scottish doctor who pioneered the field in the 1990s. In 2005, Meirow and colleagues from Sheba Medical Center published their findings in The New England Journal of Medicine.

He informed Rosenberg that the chances of success with the established procedure of egg freezing were very low.

“At that point I only had very few eggs to be frozen,” Rosenberg adds. “Prof. Meirow then suggested a very experimental treatment called ovarian tissue cryopreservation, and I agreed to be his second patient. It’s not as if I had too many other options.”

Meirow explained to JNS that the advantage of the cryopreservation method is that there’s no need for weeks of hormonal preparation and the procedure is performed laparoscopically (using small incisions with the aid of a camera) and can be done after a patient has been on chemotherapy.

Cryopreservation methods seek to reach low temperatures without the damage caused by the formation of ice crystals during conventional freezing.

Ovarian tissue transplantation is not a new technology, but the freezing and thawing of such tissue that enables women undergoing cancer treatment to resume normal menstruation and the resulting possibility of becoming pregnant is groundbreaking.

According to Meirow, about 75 patients in Israel have successfully undergone the procedure and around 275 babies worldwide have been born in this way.

An article on the wall

“No one could tell me for sure whether anything would come of this,” Rosenberg says. She recounts how the hospital staff hung an article on the wall of the unit about the one woman who had gone through the procedure and successfully given birth. “Every time I came for treatment, I would read that headline over and over again.”

Whatever Meirow tells you, it’s holy, Rabbi Avraham Elimelech Firer, founder of the Ezra LeMarpeh NGO and known for his medical advice and connections, told Rosenberg. “Do whatever he tells you to do.”

Meirow removed five tiny pieces of tissue from her ovary, each a few centimeters in size, and froze them. The following week, Rosenberg began an intense chemotherapy regimen that ultimately was successful.

One year later, Rosenberg met her future husband, and they married in August 2010.

“After our relationship became serious, I started to worry about the possibility of problems with conceiving, but I was blessed with an amazing husband. He was optimistic and said that there is no way we will not be parents.”

At this point, Meirow transplanted three of the five previously removed ovary tissue fragments via minimally invasive laparoscopic surgery. Several months passed, and following three cycles of IVF, Rosenberg became pregnant with her first son. Not long after giving birth in 2012, she conceived once again, this time naturally. A few years later, she gave birth to a third child, a boy.

When Rosenberg failed to conceive for the fourth time, Prof. Meirow evaluated her hormonal activity and suggested transplanting the remaining frozen ovarian tissue.

Fourth child born

Not long after the September 2021 procedure, Rosenberg was able to conceive naturally, and her fourth child was born seven months ago.

“When I fell ill, I could never imagine having a family this big,” Rosenberg exclaims.

Sheba has performed 750 ovarian tissue cryopreservation procedures, more than any other medical center worldwide. What was an experimental treatment back in 2008 has since become a global staple. As ovarian function returned in 95 percent of patients who underwent transplantation, and 50 percent of those managed to conceive, the success rate is “incredible,” says Meirow.

With more research funding, the professor is convinced that even more advances could be made, and the procedure could be made available to more women worldwide.

“To this day, I’m still awe-struck by how the ovaries return to function after the procedure,” he added.

“Truly, it is a miracle.”

Rosenberg emphatically agrees. “Every one of my children is an absolute miracle. Despite all the bleak statistics and predictions, at the end of the day doctors are only human but there’s someone above who is in control of everything and that’s what gave me hope.”

She can’t say enough about Meirow and his caring and personal care. “He’s not your typical doctor,” she emphasizes. “He was with me every step of the way. I’m convinced he’s an angel who was sent to me to make this happen.”

And her advice for other young women undergoing chemotherapy and radiation who wish to get pregnant? “Don’t despair, even though it may seem as if giving birth is so far from your reality. You must have faith — I wouldn’t have survived all this without it.”