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Fertility breakthrough offers hope for Gulf Arabs with genetic blood disorders

LONDON // Doctors have declared that infertility caused by treatment for inherited blood disorders affecting thousands of Gulf Arabs may at last be wiped out.

In a medical breakthrough, Emirati Moaza Al Matrooshi, a 24-year-old from Dubai who was born with the fatal blood condition thalassaemia, this week became the first patient to give birth to a healthy baby after herself being cured of the disease.

Thanks to a pioneering transplant of ovarian tissue, taken from her when she was nine years old, Ms Al Matrooshi gave birth to a healthy son of her own on Tuesday at London’s exclusive Portland Hospital.

The breakthrough has given new hope to the one in 12 Gulf citizens affected by different forms of thalassaemia, sickle cell disease and other often fatal genetic blood disorders.

Until now the chemotherapy treatment needed to cure the diseases has destroyed their reproductive function.

“This is a huge step forward. Ovarian tissue transplants will now become part of the routine management of these conditions for girls and adolescents,” said Professor Gedis Gruzinskas, editor of Reproductive Biomedicine Online.

Ms Al Matrooshi’s family was determined their young daughter would not suffer the same fate as others in her family, and began their quest to transform her life more than 15 years ago when she was still a child.

Ms Al Matrooshi said she never stopped hoping she would one day be a mother.

“It is something of a miracle that I have my son now in my hand,” she said, as her husband, Ahmed, sat at her bedside. “I had a big hope and a long journey and now we have a baby.”

Aged only nine, Ms Al Matrooshi underwent an operation by a team led by Helen Picton, professor of reproduction and early development at Leeds University in the north of England, to remove one of her two healthy ovaries ahead of the treatment to cure her thalassaemia.

“We had no idea if this would work, but we felt we had to try,” said Professor Picton. “Thalassaemia is a very nasty condition that is very prevalent in the Gulf and is often fatal. This advance will be incredibly important for this group of patients.”

Ms Al Matrooshi was then subjected to doses of toxic chemotherapy similar to cancer treatment, followed by a bone-marrow transplant from her brother, which was carried out at London’s Great Ormond Street Children’s Hospital. Although the treatment cured the thalassaemia that would otherwise cause life-threatening anaemia and heart failure, it destroyed her fertility.

The tiny piece of ovarian tissue had, however, been cut into microscopic slices in 2001 and left frozen in Leeds, in the hope that medical knowledge would advance sufficiently in the next decade for the frozen slices to be returned to her body and produce a pregnancy.

Three years ago, as Ms Al Matrooshi prepared for marriage, a decision was made to return the frozen ovary to her body, and her family was referred to Professor Claus Yding Andersen, professor of human reproductive physiology at Copenhagen University Hospital in Denmark, for the delicate transplant operation.

Within three months the four minute slivers of immature child’s ovary restored to her body in the operation had developed to become fully functioning adult tissue. Tests showed Ms Al Matrooshi had miraculously regained normal fertility and was producing eggs.

“My mum did this huge thing for me which is that she froze my ovary and saved it for me until I grew up and used it,” Ms Al Matrooshi told The Sunday Times in March.

Her odyssey at the cutting edge of medicine continued as she moved on to the Care London fertility centre. “We had no idea if the eggs were going to be viable because they came from tissue of a prepubescent girl,” said Rob Smith, the clinic’s director. “In fact it was remarkably straightforward. We had three embryos straightaway and a pregnancy on the first attempt. We’re delighted with the results. For girls in the Gulf going through treatment for thalassaemia, this is now going to be option for them which really does work.”

Sara Matthews, the obstetrician who delivered Ms Al Matrooshi’s baby said the birth was a huge step forward: “We know ovarian tissue transplantation works for older women but until now we didn’t know if we could take tissue from a child, freeze it and make it work again.”

Blood tests to screen for thalassaemia are mandatory in the UAE, but in practice many people do not undergo them or ignore the results.

Earlier this year, Essam Dohair, director of the Dubai Thalassaemia Centre, pointed out that awareness programmes have eliminated thalassaemia in countries such as Spain and Cyprus, and on the island of Sardinia, and said better education was needed about the condition in Arab Gulf states.

Mahmoud Al Ali, director of the Centre for Arab Genomic Studies in Dubai, has also highlighted the fact that the UAE – with a population of less than seven million – has worryingly high rates of inherited disorders.

“Our database shows there are 290 types of genetic disease prevalent in the country and over 1,000 different types prevalent across the whole of the Arab world. This is much higher than other countries – for example there are only 70-80 disorders listed in the equivalent Scandinavian database,” he said.

“There is no question we need more awareness of this problem.”

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