It is only January and already the Oncofertility Saturday Academies (OSA) are off to a busy start. Last weekend, Mary Zelinski, PhD, who heads one of the Oncofertility Consortium‘s research projects, launched this year’s Oregon academy at the Oregon Primate Research Center (ONPRC). A group of 10 high school students comprised of eight girls and two boys got an overview of oncofertility and a tour of the research center. The students come from different schools, two of them driving up to an hour to attend the Saturday programs.

In addition to a tour of the primate center, the OSA students performed hematoxylin and eosin (H&E) staining on sectioned ovaries. This coming weekend, they will have the opportunity to view these sections under a microscope. H&E staining is widely used in biological research as it stains the cell nucleus blue and other structures a pink or red color.  This year, the Oregon OSA will meet in the newly completed Science Learning Lab at the ONPRC. The educational research lab, supported by a generous grant from a private donor, can accommodate up to 24 students and will greatly expand the opportunities available for visitors to interact with Primate Center researchers. An open house will be held tomorrow, Friday, January 27^th and will provide the OSA students a place to learn about oncofertility and basic science research over the next few weeks.

Simultaneously, tomorrow is the launch of the Chicago OSA program with juniors and seniors in high school from five schools in the Chicagoland area. In the next few weeks we will, continue to share more about both of these exceptional programs, and the OSA programs at the University of Pennsylvania and University of California at San Diego.

In case you haven’t heard about the Cancer Smashers, you must continue reading and get to know this fantastic group of young people banning together to raise money to eradicate cancer. Let me begin by telling you who they are and what they’re all about. Then we’ll get into all the cool things that they do to raise money and awareness for cancer research.

For starters, Cancer Smashers is a unique group of kids ranging in age from 10 years old to 19 years old who joined forces in 2011 to raise money and awareness for cancer research.  Their goal is to help promote the H Foundation, an all-volunteer group founded by businesspeople in the western suburbs of Chicago that decided they could make a difference in the fight against cancer, and the Goombay Bash, an annual cancer fundraiser held in downtown Chicago. Money raised by the Cancer Smashers and the H Foundation goes directly to cancer research and funds work being done at Northwestern University’s Robert H. Lurie Comprehensive Cancer Center.

The Cancer Smashers help out by doing a variety of activities from assisting at events to building floats for parades or simply by being a support system to someone who is diagnosed with cancer.  Most recently, the Cancer Smashers came to the Woodruff Lab at Northwestern University to spend one-day learning about scientific research through lab exercises, such as extracting DNA from strawberries and also making alginate beads. Founder and Chair of Cancer Smashers, Beth Tischler, thought it was important for the kids to see exactly where the money they raise is going to, by visiting the Woodruff Lab and participating in some of the work the researchers do. Nadia Reynolds and Cathryn Smeyers, members of the Woodruff Lab and organizers of the Oncofertility Saturday Academy (OSA), participated in the event explaining, “The kids were really enthusiastic and excited to be a part of the research that’s being done here at Northwestern.”

What’s up next for the Cancer Smashers? For the week of January 23-27, the school’s Student Council will be selling paper “fists” for only $1.00. The buyer of the fist will personalize it by writing the name of a person who has been affected by cancer that they would like to honor. The fist will then be displayed on the walls of the school of their choice. The school district that sells the most fists is the winner!! To learn more about the Cancer Smashers and watch some videos about them, go to www.cancersmashers.com. You can also see them in action this Friday on CBS 2 news. Make sure you check it out!

This March, the United States Supreme Court will hear oral arguments about its first case on oncofertility. The case involves the Capato couple, a husband and wife from Florida who dealt with Mr. Capato’s diagnosis of esophageal cancer.  Prior to beginning cancer treatment, the Capato’s learned that Mr. Capato’s chemotherapy could destroy his fertility and, as such, choose to preserve his fertility by banking sperm.  Despite the cancer treatment, Mr. Capato passed away from his disease. Mrs. Capato decided to continue their wishes as a couple and use Mr. Capato’s banked sperm to have their children through in vitro fertilization.

In 2003, 18 months after the death of her husband, Mrs. Capato gave birth to twins. As a widowed mother of twins, Mrs. Capato applied for Social Security survivors’ benefits. According to the Social Security Administration website, these benefits are intended to help the family of a worker who passes away and that 98 of every 100 children are eligible for benefits if a working parent dies.

However, Mrs. Capato’s application for her children to receive survivors’ benefits was denied. According to the Social Security Administration, the Capato twins are not actually Mr. Capato’s children since they were conceived after his death. This first decision was based, in part, on a Florida law that states that a child cannot receive inheritance from a parent who was dead at the time of conception. Mrs. Capato appealed this decision twice and was denied both times. Finally, the Third Circuit decided on the Capato twins’ behalf stating that the term “child” refers to the biological offspring of Mr. Capato, which they are.

The case that is going to the Supreme Court is called Astrue v. Capato as the Social Security Administration, is commissioned by Michael J. Astrue. Evidently the Social Security Administration has a policy of denying survivor benefits when a child is conceived after a parent’s death and they are asking for guidance for the court on when to decide when these children should be beneficiaries.  We look forward to hearing more about this case in the next few months and will keep our readers updated. More insights into the legal aspects of oncofertility are available from some of the researchers at the Oncofertility Consortium:

• Medical hope, legal pitfalls: Potential legal issues in the emerging field of oncofertility by Gregory Dolin, MD, JD; Dorothy E. Roberts, JD; Lina M. Rodriguez, Teresa K. Woodruff, PhD
• Domestic and International Surrogacy Laws: Implications for Cancer Survivors by Kiran Sreenivas and Lisa Campo-Engelstein, PhD

In the next few weeks, the University of Illinois at Chicago (UIC) will be hosting an exciting new Grand Rounds session with Oncofertility Consortium  member, Dr. Jennifer Hirshfeld-Cytron, as the guest speaker.  “Legal and Ethical Implications of Fertility Preservation: A Case Based Approach,” will take a closer look at the ethics behind oncofertility on February 8th from 12-1pm at UIC.

Dr. Hirshfeld-Cytron will begin by discussing the various fertility preservation options patients have based on their diagnosis and cancer treatment plan. She will also discuss how patient care is handled collaboratively in this burgeoning new field. Much of the success in a multidisciplinary field is based on communication and how effectively teams work together. The Oncofertility Consortium can be seen as a model for team science through its ability to bridge the gap between clinicians, researchers, and the social sciences.

Finally, Dr. Hirshfeld-Cytron will discuss current literature related to the clinical, legal, and ethical implications of fertility preservation strategies in breast cancer, ovarian germ cell cancer and pediatric patient populations.  Read Dr. Hirshfeld-Cytron’s recently published a paper with Drs. Gracia and Woodruff entitled, Nonmalignant Diseases and Treatments Associated with Primary Ovarian Failure: An Expanded Role for Fertility Preservation.  A panel discussion will follow with  clinicians and scholars  from obstetrics, gynecology, pediatrics, law, and hematology-oncology.  For more information or attend this Grand Rounds, contact L. Anderson-Shaw at 312.413.3805.  We hope to see you there!

From left: Irene Su, Laxmi Kondapalli and Maureen Prewitt

This is the final installment in a 3-part blog series featuring Oncofertility Consortium member, Laxmi Kondapalli, MD, MSCE.  In this post, we take a look at her current position at the University of Colorado and her latest research endeavors. To read the 1st  blog, click here and for the 2^nd post, click here.

Mid-2011,  while Laxmi was finishing up her clinical work at the University of Pennsylvania (Penn), she was recruited by the University of Colorado in Denver to start the first fertility preservation program in the mountain region. Laxmi accepted with the goal of creating a comprehensive wellness program at Denver and in September of 2011, she began working at her current position as an Assistant Professor of Obstetrics and Gynecology.

Laxmi is working on a women’s reproductive health research grant, meaning that 75% of her time is protected for research, and 25% of her time is reserved for clinical care.  According to Laxmi, “Given that I do clinical research and that my area of interest is fertility preservation, there’s a lot more fluidity in the composition of my time because so many of my patients that I see clinically, I also try to recruit into my research protocols.” Even though the University of Colorado is a part of the National Physicians Cooperative (NPC), they had yet to have any patients who had undergone ovarian tissue freezing. Laxmi made it her mission to make fertility preservation a big presence on the university campus. She works with the cancer center, breast oncology unit and she has special privileges at the children’s hospital working with the pediatric team on fertility.  Laxmi explains, “I want to make sure that fertility preservation is a component of care for all patients.”

Currently, Laxmi is involved in several research projects for men and women including; Reproductive Outcomes in Cancer Survivors: Examining Perinatal Outcomes in the Women with a History of Cancer; Semen Parameters in Adolescent Male Cancer Patients; and Reproductive Potential in Young Breast Cancer Survivors: Interplay between Markers of Ovarian Reserve, Metabolism and Tumorogenicity. However, her research is not just science based, it has an outreach component as well. In Fall 2012, in conjunction with Fertile Action and the Oncofertility Consortium, Laxmi is launching the PACT program (Parenthood After Cancer Treatment), which is a patient and provider outreach program on fertility preservation. Patients and providers spend a day learning about the long term consequences of cancer treatment, fertility preservation and where to go to access it.

In sum Laxmi says,  “I stayed in academics because I like academics and because I am the product of great mentorship. I hope to inspire residents and fellows that I work with in the same way that I was inspired.”

A recent paper by Oncofertility Consortium trainee, Jayeon Kim, MD, indicates that certain women are more likely to undergo fertility preservation prior to cancer treatment than others. The authors, Jayeon Kim, Kutluk Oktay, Clarisa Gracia, Sanghoon Lee, Christopher Morse, and Jennifer E. Mersereau, found that women were more likely to under go embryo or egg banking if they were wealthier, thinner (lower BMI), had less-advanced disease, and did not undergo neoadjuvant treatment prior to surgery.

In the paper, “Which patients pursue fertility preservation treatments? A multicenter analysis of the predictors of fertility preservation in women with breast cancer,” the authors examined demographic and clinical information of women diagnosed with breast cancer at three centers around the United States. While previous studies have asked which factors affect the likelihood that a woman will be referred for a fertility preservation consultation, this one evaluated which women are most likely to undergo fertility preservation treatment after that initial consult.

Of the four factors that positively correlated with undergoing fertility preservation treatment, only one of them is modifiable in the short time after a cancer diagnosis. Neoadjuvant therapy includes chemotherapy, radiation, and hormonal treatments prior to surgery. It is often given to patients with more advanced disease and those with a shorter time period between diagnosis and the onset of treatment, which may prevent time for the hormonal stimulation of the ovaries required for embryo and egg banking. One option for these women may be ovarian tissue cryopreservation, an experimental fertility preservation technique that does not require two weeks of hormonal stimulation.

Of the 185 women in the study published in Fertility and Sterility, more than half of them underwent fertility preservation treatment from 2005 to 2010. In addition to the factors that positively correlated with treatment other factors are equally interesting. The authors found that age, having children previously, and presence of a partner or spouse did not affect fertility preservation treatments. Interestingly, insurance coverage status also did not have an effect, possibly because insurance coverage for fertility preservation is inconsistent.

This significant work can help oncofertility specialists better care for their patients in the future. As one of the mission’s of the Oncofertility Consortium is to train the next generation of experts in cancer and fertility, we are proud of the research that Dr. Kim has performed. Read more about the oncofertility training program.

This is the 2^nd in a 3-part blog series featuring Oncofertility Consortium superstar, Laxmi Kondapalli, MD, MSCE.  In this post, we focus on her time at the University of Pennsylvania. To read the 1^st blog, click here.

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Knowing that she wanted to continue to work in fertility preservation and receive superior training, Laxmi only applied to a limited number of reproductive endocrinology (REI) fellowships, one being at the University of Pennsylvania (Penn). What better place to graduate onto than Penn where she could remain in the hub of the Consortium while building her skills as a top clinician?  According to Laxmi, “Penn was a perfect fit for me because it’s excellent for REI training and the reason why I wanted to go to Penn was because they also have a specialized training program in clinical epidemiology.”

Another significant component of Laxmi’s career path and something pertinent to her decision to go to Penn, was her ability to do research and collaborate with bench scientists.  Laxmi says, “I think with my skill set, I’m really a clinician at heart – I would be much better at doing clinical research and patient facing research, and that’s why I chose Penn.” At Penn, she was able to really focus on the clinical aspects of fertility preservation, laying the framework for the well-rounded doctor she was to become.

Laxmi spent 3 years at Penn (2008-2011) getting clinical experience in REI and earning a Masters of Science in Clinical Epidemiology, working with some of the top clinicians in the field. “I worked with [Consortium member] Clarisa Gracia and saw fertility preservation patients with her both in-patient and out patient.  I was able to navigate patients and care for them in terms of doing the egg and embryo banking, doing the ovarian transpositions and we also did a fair number of cases of ovarian tissue freezing as well.”

For Laxmi, one of the most significant aspects of her tenure at Penn was the opportunity to do a variety of different things in her field.  It was important to her to be trained in ovarian transplantation, as very few clinicians actually know how to do this. During her 2^nd yr of fellowship, Laxmi trained with Sherman Silber in St. Louis spending two days in the operating room with him learning his technique for vitrification of ovarian tissue and for transplantation. Laxmi says, “That was a very cool opportunity and why I think that I’m very unique in terms of my background because a lot of people say that they do fertility preservation and they kind of know how to bank eggs and embryos, but I have a much more global perspective about this field, and I’ve had great opportunities to get specialized training and some very high tech, cool things like ovarian transplantation.”

As her time at Penn came to a close mid-2011, Laxmi was on to her next big adventure…

Laxmi Kondapalli being interviewed by Dayle Cedars from Channel 7 news in Denver

One of the many, if not one of the most, important aims of the Oncofertility Consortium and its emphasis on fertility preservation research and clinical care, is “training the next generation.” Not only is the mission of the Consortium to improve fertility outcomes for patients undergoing cancer treatment, but it is also to ensure that future basic scientists and clinicians continue to expand current knowledge, research, clinical practice, and training in fertility preservation outcomes.  Laxmi Kondapalli, MD, MSCE, Assistant Professor of Obstetrics and Gynecology at the University of Colorado and Women’s Reproductive Health Research Scholar in the Division of Reproductive Endocrinology and Infertility is a realization of this goal. Let’s start at the beginning…

In March 2006, Laxmi was finishing up her residency training at Northwestern University in Obstetrics and Gynecology when she met Teresa K Woodruff, PhD, Director of the Oncofertility Consortium. Laxmi shared her interest in Reproductive Endocrinology (REI) with Dr. Woodruff, but expressed her desire to do basic science/bench research first, before embarking on clinical training and practice. According to Laxmi, “Meeting Dr. Woodruff changed the trajectory of my career.  She has incredible vision, particularly for someone who is not a clinician, on how to bridge science with individual care.”

Shortly after her meeting with Dr. Woodruff, Laxmi started working in the Woodruff Lab in August 2006. It was at the start of her tenure in the lab when she found out that Dr. Woodruff was one of the finalists for the prestigious National Institutes of Health (NIH) Roadmap Grant (aka, the grant that brought the “idea” of the Oncofertility Consortium to fruition). Together, they put the 1,000 page grant together over a 10 week period with help from members of the Woodruff Lab and other academics from within Northwestern and around the country. Laxmi explains, “It was being at the right place at the right time and the Oncofertility Consortium was a perfect fit for me because of my interest in REI and because it was a way for me to really see how you can translate work that we do in the laboratory to really impact clinical and patient care.”

In 2007, the Oncofertility Consortium was funded by the NIH, and Laxmi was A) not only a first-time grant writer, but a grant writer for one of the biggest grants given out (“for me, it was a valuable experience on so many levels”), B) processing and freezing A LOT of ovarian tissue in her lab work and C) navigating patients with the Fertility Preservation Patient Navigator who was receiving referrals from all over the country to do tissue freezing. By 2008, after two years in the Woodruff Lab working hands on with tissue, Laxmi was ready to embark on an REI fellowship and she had her sights set on an institution that would allow her to expand her work in fertility preservation while ideally being involved with the Oncofertility Consortium.

Stay tuned for Part 2 of the amazing, fabulous Laxmi Kondapalli success story!

Today we are continuing our coverage of the scientific correlation, or lack thereof, between infertility treatments and cancer. We’ve recently put out two blogs discussing new scientific examinations of hormonal stimulation and breast and ovarian cancer. A third study has just been published on the roles of three important hormones, follicle stimulating hormone (FSH), luteinizing hormone (LH), and human chorionic gonadotropin (hCG), on breast cancer cell growth.

In the paper, “Impact of infertility regimens on breast cancer cells: follicle-stimulating hormone and leuteinizing hormone lack a direct effect on breast cell proliferation in vitro,” researchers examined how FSH, LH, and hCG affect the growth and proliferation of multiple breast cancer cell lines in the laboratory. These three hormones are used during in vitro fertilization (IVF) to stimulate the development of a woman’s follicles, which are then removed and fertilized with sperm.

The authors, Boukaidi, Cooley, Hardy, Matthews, Zelivianski, and Jeruss, examined how breast cancer cell lines in a 3D culture system responded to the three hormones.  The found that, when treated with individual hormones, neither the growth nor division of breast cancer cells were altered. In addition, one of the cell lines did respond to a combination of FSH and hCG, which caused decreased cell division and size. This result provides evidence that FSH, LH, and hCG may not directly increase breast cancer risk during infertility treatments.

Future studies will be needed to further explore the effects of additional factors, such as estrogen, on breast cancer growth and proliferation. Read the full article in Fertility and Sterility.

An interesting journal article that came across my desk analyzes the ambiguous guidelines issued for assisted reproductive technologies (ART) in Ireland.  As it stands, there is no controlling legislation for ART in Ireland, so the guidelines issued by the Medical Council (the group responsible for setting professional and ethical medical guidelines in Ireland) are what reproductive scientists and clinicians must follow in their work. “The Evolution of Health Policy Guidelines for Assisted Reproduction in the Republic of Ireland, 2004-2009,” by David J. Walsh, Mary L. Ma, and Eric Scott Sills in Health Research Policy and Systems compares the policy guidelines set forth in 2004 to the most current guidelines issued in 2009 by the Medical Council, arguing that copious guidelines need to be established.

A positive change that can be seen in the revised guidelines issues in 2009, is the Council’s support for more accreditation for ART practitioners and better record keeping and auditing practices. However, the overwhelming ambiguity placed on surplus embryos,  donor compensation  and embryo disposition may restrict access to IVF services. While the Medical Council states that the ultimate responsibility for the regulation of ART falls to the Oireachtas (national parliament or legislature of Ireland), the Oireachtas have remained silent on these issues  leaving the burden up to the Medical Council.

Another dynamic to add to the mix is the reconfiguration of the Medical Council. The Council has 25 members historically comprised of physicians; however, new legislation passed in 2007 requires that 9 of those members cannot be medical practitioners in Ireland or elsewhere. Thus the guidelines set in  2004 and those set in 2009 were established by 2 completely different groups, the first being made up of  mainly “pro-life” members.  This informed many of the original guidelines such as limiting IVF treatment to unexplained infertility and the stipulation that embryos must be donated before deliberately being destroyed. In 2009, the guidelines state that IVF is available to individuals when “no other treatment is likely to be effective,” and the option to donate embryos was retracted making destruction more favorable to donation.

Although the authors agree that ART legislation is the ultimately responsibility of the Oireachtas, they argue that enacting such legislation could take years.  Thus, the authors conclude that the Medical Council should be the deciding body setting comprehensive guidelines for ART in an attempt to address the complex ethical issues that are either being overlooked or underscored. To read, “The Evolution of Health Policy Guidelines for Assisted Reproduction in the Republic of Ireland, 2004-2009,” please click here.