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Preserving fertility after cancer diagnosis

March 16, 2012 12:00:00 AM PDT
Effective cancer treatments mean more young cancer patients are surviving. But the same medications saving their lives are also killing their chances of having children. Now there's an experimental procedure that's helping teen cancer patients preserve their fertility.

From studying chemistry to winning homecoming queen, life for straight-"A" student Julianne Mai, 17, was all about school, until a few weeks ago.

"I guess I was kind of speechless," said Julianne. "I didn't think that someone like me could have cancer."

Now Julianne's on her second round of chemotherapy. Not only is she fighting cancer, she also had to make a choice about her future as a parent.

"Being a 17-year-old, babies aren't exactly what I have in mind all the time," said Julianne. "It's just school and my boyfriend."

It's a decision 130,000 newly diagnosed cancer patients of reproductive age must make every year.

Dr. Steven Lindheim heads up one of 50 national oncofertility sites addressing the problem.

"What we can provide for them is the ability after they've done their therapy to still have a family," said Lindheim.

Since Julianne needed chemotherapy right away, she opted to have one of her ovaries removed and frozen for the future.

"To date, ovaries have been transplanted either back in the forearm or in the chest wall," said Lindheim.

That's because of the rich blood supply found there. Later, in-vitro fertilization can take place. The technique is still experimental and has only resulted in 18 pregnancies worldwide.

"It's a new process," said Julianne. "I don't know if it's going to work, but it's for 10 years from now."

For now, she's taking her cancer one day at a time.

In many cases fertility-preservation options are not covered by insurance. The average cost of ovarian tissue freezing is $12,000. Dr. Lindheim also works with the LIVESTRONG organization's "Sharing Hope" program, and says the foundation can help patients arrange for discounted services and donated medications.

NEW OPTIONS FOR FERTILITY AFTER CANCER

BACKGROUND: Survival rates among young cancer patients have steadily increased over the past four decades in part because of the development of more effective cancer treatments. Today, both women and men can look forward to life after cancer, yet many may face the possibility of infertility as a result of the disease itself or these lifesaving treatments. (SOURCE: Oncofertility Consortium at Northwestern University)

WOMEN AND INFERTILITY: Women are born with a finite number of eggs. As they age, the supply diminishes until there are no more viable eggs and menopause begins. Standard cancer treatments, including chemotherapy, radiation and surgery, damage or destroy eggs, essentially inducing early menopause in many women. Women faced with cancer need to make decisions quickly about ways to potentially preserve their fertility. (SOURCE: Stanford Cancer Center)

METHODS TO HAVE CHILDREN AFTER CANCER: Fortunately, women have more choices than ever to have children after cancer from new storage methods for eggs to fertility-sparing surgeries.

  1. Embryo freezing: Embryo freezing, or embryo cryopreservation, is the most common and successful method of preserving fertility today. Mature eggs are removed from the woman's ovaries and fertilized in the lab. This is called in vitro fertilization (IVF). The embryos are then frozen for future use after cancer treatment. This option works well for women who already have a partner, though single women can still have in vitro fertilization using donor sperm. Since each egg can most likely produce a single embryo at best, a woman will have a better chance of a successful pregnancy by storing several embryos. Hormones can be used to ripen several eggs at once. In most women, this means starting a cycle of hormone shots on day 3 of her menstrual cycle and continuing them for 2 to 3 weeks until many eggs are mature (often around 12 in a woman under age 35).
  2. Ovarian transposition: Ovarian transposition means moving the ovaries away from the target zone of radiation treatment, usually during laparoscopy. Surgeons will usually move the ovaries above and to the side of the central pelvic area. This procedure typically does not require being in the hospital. It can be used either before or after puberty. The success rates have usually been measured by the percentage of women who regain their menstrual periods, not by being able to have a live birth. Typically, about half the women start menstruating again.
  3. Radical trachelectomy: Radical trachelectomy is an option for cervical cancer patients who have very small, localized tumors. The cervix is removed but the uterus and the ovaries are left. Trachelectomy appears to be just as successful as radical hysterectomy in removing cervical cancer in certain women. Women can become pregnant after the surgery, but are at risk for miscarriage and premature birth because the opening to the uterus may not close as strongly or tightly as before. These women will need specialized obstetrical care while pregnant.
  4. Fertility-sparing surgical procedure: This surgical treatment can be used in some women with ovarian cancer in only one ovary. The cancer must be one of the less aggressive types, like borderline, low malignant potential, germ cell tumors, or stromal cell tumors. A surgeon will try to remove just the ovary with cancer, leaving the healthy ovary and uterus in place. If there is a risk of the cancer coming back, the surgeon may later remove the unaffected ovary after the woman has finished having children. (SOURCE: Stanford Cancer Center)

ONCOFERTILITY: Oncofertility is an interdisciplinary field at the intersection of oncology and reproductive medicine that expands fertility options for cancer survivors. The Oncofertiltiy Consortium was launched with a grant from the National Institutes of Health and represents a nationwide, interdisciplinary, and interprofessional network of medical specialists, scientists, and scholars who are exploring the relationships between health, disease, survivorship and fertility preservation in young cancer patients. (SOURCE: Oncofertility Consortium at Northwestern University)


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