In April, the Oncofertility Consortium hosted a Virtual Grand Rounds with Clarisa Gracia, MD, MSCE, entitled, “Case Studies in Oncofertility,” in which she discussed five theoretical young cancer patients and how oncofertility could be incorporated into their medical care. These patients included pediatric girls, adolescents, and young adult women with a variety of diseases including lymphoma, leukemia, ovarian, breast, and bone cancer. Dr. Gracia’s talk not only included the clinical recommendations for each of these patients, but also the scientific evidence that supported such suggestions. If you didn’t watch the live Rounds you can view a recording of the talk, with an option to obtain CMEs from the recording.  Following are some of the questions and answers posed to Dr. Gracia that she was able to answer after the Rounds ended.

Question: Are there differences in the impact of chemotherapeutics on primordial vs. growing follicles?

Answer: There is destruction of both growing follicles and primordial follicles. The article, “How do chemotherapeutic agents damage the ovary?” by Morgan, Anderson, Gourley, Wallace, and Spears provides a good review of some of the evidence. Briefly, chemotherapeutics may affect a variety of cell types within the ovary. A reduction in primordial follicles may be caused by direct damage by chemotherapeutics. However, chemotherapy also damages growing follicles, which increases recruitment of the primordial pool of follicles to begin growing. This increased recruitment also means that chemotherapy may indirectly decrease primordial follicle numbers.

Question: How do you build relationships with oncologist to ensure they are willing to start the fertility preservation discussion with patients?

Answer: It is important to reach out to oncologists and oncology nurses and let them know that you provide fertility preservation services for their patients. Provide flyers, letters, and make an effort to give presentations to oncology groups in your area. Please refer to the oncofertility website for more information.

Question: Are there functional analyses after uterine or whole body irradiation to determine if the uterus will be able to carry a healthy growing fetus to term?

Answer: The studies have focused only on uterine size and blood flow post radiation exposure, not functional in vitro studies.

Question: What do you/your patients consider a good number of oocytes? If a patient doesn’t get enough after one stimulation protocol, will you allow them to delay treatment in order to do another?

Answer: That is a difficult question and depends on a patient’s age and egg quality. We generally think getting more eggs is better than few eggs, but there is no guarantee of pregnancy even with many eggs. Ideally, a patient gets at least 10 oocytes in an egg retrieval. It is reasonable to pursue another stimulation cycle only if the oncologist feels comfortable delaying therapy.

Join the next Oncofertility Virtual Grand Rounds in June on the topics, “Sexuality After Cancer” with Dr. Kamaljeet Murthy and “Hormonal impact of cancer treatment and management of hormonal symptoms in female cancer survivors” with Dr. Catherine Stika.

This Thursday, the Oncofertility Consortium is happy to host a Virtual Grand Rounds with two clinician-researchers from the Chicago area, Jennifer Hirshfeld-Cytron, MD, and Mary Ellen Pavone, MD. Drs. Hirshfeld-Cytron and Pavone are both Assistant Professors in the departments of Obstetrics and Gynecology, at the University of Illinois Medical Center and Northwestern University, respectively. To launch our efforts to link up oncology and reproductive providers, the two presenters will give an up-to-date overview of the gonadotoxic effects of different cancer treatments including surgery, chemotherapy, and radiation therapy. Furthermore, they will provide an increased awareness about the established and emerging fertility options for young female cancer patients, before, during, and after cancer treatment.

The Virtual Grand Rounds will occur this Thursday, December 13, at 10 AM Central Time, with a talk entitled, “Reproductive Impact of Cancer Treatments and Fertility Preservation Options for Cancer Patients.” The Virtual Grand Rounds are live videoconferences with experts in the oncofertility field and allow attendees to participate through a live videochat. Virtual and in-person attendees to the rounds can also receive free continuing medical education (CME) credits by following the instructions here. Within one week of the rounds, a video recording will be posted on the Oncofertility Consortium website and CME credits also made available to viewers. To read more about receiving education credits from the Oncofertility Consortium, read about the Oncofertilty Online program.

At 10 AM, Central time this Thursday, click here to watch Drs. Hirshfeld-Cytron and Pavone present their Virtual Grand Rounds. If you are an Illinois reproductive or oncology provider, and would like to increase your local network, contact oncofertility@northwestern.edu or call 312.503.2506.

There are more than 400,000 female cancer survivors below age 40 in the United States today, due primarily to the relatively large number of young women who are diagnosed with, and beat, breast cancer. Approximately 70% of breast cancers are identified as estrogen receptor-positive (ER-positive), meaning they express estrogen receptors and grow when exposed to the hormone estrogen. Tamoxifen, an estrogen receptor antagonist (meaning it prevents activation) is used to reduce cancer recurrence and mortality in premenopausal women with ER-positive cancers. Current general practice encourages women to take Tamoxifen for at least 5 years after an initial cancer diagnosis to reduce the risk for relapse but a recent study indicates that longer Tamoxifen treatment may be even better.

The recent study published in The Lancet examined the relapse and mortality rates of women who took Tamoxifen for 10 years after initial cancer diagnosis, rather than the established 5. The authors identified that 15 years after diagnosis, cancer recurrence rates were 3.03% in the 5-year tamoxifen-treated women, compared to 2.54% in the 10-year treated women. Similarly, death in these survivors occurred in 2.29% of the 5-year treated women versus 1.64% in the women who were on tamoxifen for 10 years. These results indicate that some women may want to extend tamoxifen therapy to get maximal benefit from the drug.

It is important to note that, in the study, the majority of benefit from tamoxifen did occur in the first five years of treatment so some women may still choose to take the drug for 5 years. Multiple factors, including side effects that negatively impact quality of life, may cause women to choose the shorter treatment schedule. These include endometrial cancer, venous thromboembolic events, cataracts, hot flashes, and other symptoms associated with menopause. Currently, up to 50% of patients discontinue tamoxifen prior to reaching the 5-year mark and women under age 40 are at highest risk to discontinue therapy.

In addition to side effects, considerations about fertility may affect tamoxifen adherence rates in younger women. Tamoxifen is a teratogen, meaning it can cause prenatal malformations. Thus, young cancer survivors who are interested in pregnancy may be hesitant to take the extra years of tamoxifen examined in the study. For example, a 30 year-old woman diagnosed with cancer may be able to wait until age 35 to have children but not able to wait until age 40, when her reproductive chances have declined significantly. Given the new study and individual considerations for young women, each ER-positive breast cancer survivor should discuss the pros and cons of extending tamoxifen therapy in her specific case, with her doctor. If you have a question about your reproductive options after a cancer diagnosis, contact the Oncofertility Consortium‘s FERTline at 866-708-FERT (3378).

The oncofertility community aims to educate both oncology and reproductive specialists throughout the United States and across the globe. Over the past five years, the Oncofertility Consortium has done this through an annual conference and monthly Virtual Grand Rounds. This year, we’ve gone one step further in providing clinical education by offering continuing medical education credits (CMEs) to health care providers, including physicians, nurses, and physicians assistants.

This program, called Oncofertility Online, allows health care providers to watch virtual presentations from the 2012 Oncofertility Conference and receive CME credits for their participation. In addition, providers can now watch live or recorded presentations from selected Virtual Grand Rounds (October 2012 – October 2013).

If you are interested in receiving CMEs by watching these recordings, just find a presentation and follow the instructions, which include taking a brief pre-test, watching the recording, and taking the post-test!

Also, you can join the next live Virtual Grand Rounds on Thursday, December 13th, 2012 at 10 AM Central Time on the “Reproductive Impact of Cancer Treatments and Fertility Preservation Options for Cancer Patients” which will be led by Jennifer Hirshfeld-Cytron, MD, MSCI, Assistant Professor, Obstetrics & Gynecology, University of Illinois Medical Center and Mary Ellen Pavone, MD, Assistant Professor, Obstetrics & Gynecology, Northwestern University. View the current list of the 2013 Virtual Grand Rounds here.

Tomorrow launches this year’s cadre of Virtual Grand Rounds for the Oncofertility Consortium. For those who are not aware of these special rounds, they are live videoconferences with experts in the fields of reproduction, cancer, and oncofertility. The rounds provide researchers, clinicians, and others the opportunity to hear emerging research findings from anywhere across the globe and participate through a live videochat. This year, the Oncofertility Consortium is also able to offer free CME credits to health care providers through these live virtual events.

We are happy to be hosting Zsolt Peter Nagy, PhD for his presentation tomorrow, October 11, 2012 at 12 PM Central time, for his talk on vitrification, the rapid freezing technique used in assisted reproductive technologies (ART). Dr. Nagy will discuss the current state of vitrification in two fertility preservation options for young female cancer patients, oocyte and embryo cryopreservation.

At Noon, Central time, click here to watch Dr. Nagy present his Virtual Grand Rounds

Or sign up to receive free CME credits while participating in Dr. Nagy’s presentation

The 2012 Oncofertility Conference: Dialogues in Oncofertility begins next Thursday, September 27^th in Chicago, IL. This 6^th annual conference will include talks from experts across the globe on topics that range from factors influencing primate folliculogenesis to the psychosocial needs of young cancer patients. The keynote presentation from Dr. Hamish Wallace, will address, “Fertility Preservation for Young People with Cancer: What Are the Remaining Challenges?” In addition, an evening cocktail hour will include a celebration for pediatric and young adult cancer survivors with national advocates, survivors, researchers, and clinicians…and a special piano performance from the founder of the young adult cancer advocacy organization, Stupid Cancer, Matthew Zachary.

For those who are not able to attend the conference in person, we are happy to announce that the educational presentations will be available through live web streaming. Virtual attendees can join in from across the globe by going to this website (http://bit.ly/virtualoncofert) during the conference hours on Thursday, September 27 – Friday, September 28. In addition, complementary CMEs, nursing, and physicians assistant credit hours will be available to online attendees. Learn more about this virtual broadcast and pre-register to receive CMEs through the virtual conference.

To attend the 2012 Oncofertility Conference in person, limited registration is still available. We look forward to seeing you there!

Here at the Oncofertility Consortium, we are busy putting the final touches on the upcoming 2012 Oncofertility Conference: Dialogues in Oncofertility. At the conference, experts will discuss which cancer treatments are likely to damage later reproductive ability for men, women, and children and  new fertility preservation methods. At this year’s sixth annual conference on September 27 – 28, 2012 in Chicago, IL, clinicians and scientists will discuss recent advances in oncofertility scientific and medical treatment.

The program for this two-day conference on fertility after cancer features translational and clinical research on fertility preservation, lessons learned from individual fertility preservation programs, a speech and special performance by the founder of the adolescent and young adult cancer advocacy group, Stupid Cancer, and a Keynote Symposium by Hamish Wallace, MD (Royal Hospital for Sick Children, Edinburgh). During the two days of the conference, more than 20 invited speakers from across the globe will present cutting-edge information to attendees.

Health care providers will be provided with CME or nursing contact hours at no additional cost. For more information or to register for the conference, visit the website at http://bit.ly/oncofert12 or email oncofertility@northwestern.edu. The 2012 Oncofertility Conference is funded by the NIH (Grant 5R13HD063248-03), and an unrestricted educational grant from Ferring Pharmaceuticals, Inc.

To learn more about fertility and cancer, visit SaveMyFertility.org and download the free iPhone app.

A new website has just been launched to provide assistance to young patients wishing to learn about their reproductive options in the midst of a cancer diagnosis. As many of you know, the Oncofertility Consortium has a patient navigator for Fertility Preservation, Kristin Smith, who answers the national (and global) FERTline hotline. Kristin is experienced at talking to patients and providers about the best reproductive options for cancer survivors at all stages of treatment. But what happens when a young person would like to review these options in the middle of the night or do not have access to a phone?

Now patients and their clinicians can go to the new Patient Navigator for Fertility Preservation website, which includes an interactive tool to provide information on the available options for males and females, before or after puberty, and before, during, or after cancer treatment. This website can be found at FertilityPreservation.Northwestern.edu.

On the website, patients can also watch tutorials that explain normal male and female fertility and how these are impacted by different cancer treatments such as radiation, chemotherapy, and surgery. They can also watch videos of personal stories from people young people who have chosen a variety of the fertility preservation options available, including sperm banking, oocyte and embryo banking, and ovarian tissue cryopreservation. Watch the videos of Tiffany, Jonny, Matthew, Jenna, Dan, and Abby here.

The website is also built in a new platform, called responsive design, which allows viewers to interact with the site on any device including PC, tablet, or cell phone. The website automatically changes configuration for each type of device allowing for a smooth user experience for every person viewing the site.

Finally, the patient navigator website, which is hosted by the Department of Obstetrics and Gynecology at Northwestern, identifies some of the many partner programs within the Chicago area, including other departments within Northwestern, the Institute for Women’s Health Research, and the Ann & Robert H. Lurie Children’s Hospital of Chicago.  Together these resources aim to ensure that all young patients and their families are provided with reproductive options in the midst of a cancer diagnosis.

On March 23, 2010 the Patient Protection and Affordable Care Act was signed into law. This bill was designed to fill some of the health care gaps that prevented many Americans from receiving affordable health insurance. Since that time, the legality of the bill has been questioned and this past Thursday, the Supreme Court of the United States of America found the principle components of the bill to be constitutional in a case titled National Federation of Independent Business v. Sebelius (the Secretary of Health and Human Services).  One of the most controversial aspects of the bill requires that all American citizens acquire health care insurance or face a tax penalty, was also upheld. Many young cancer patients and survivors who are concerned with their fertility have also been affected by the bill and are assured that the changes implemented by the law are here to stay, as follows.

Beginning on September 23, 2010, the bill established that children under age 19 could no longer be denied health insurance coverage due to a preexisting condition, allowing parents of young children to freely change jobs without fear that their child would be denied insurance coverage under the new employer’s insurance. That date was also significant for older children, as children were allowed to maintain health care coverage under their parents plan until the age of 26 (previously it was 18 or higher if the child was a full time student) regardless of where they live or dependent/marital status.

Now that the Supreme Court has upheld the legality of the Act, additional changes will be implemented on January 1, 2014. Starting then, health insurance companies will no longer be able to deny coverage to anyone because of pre-existing conditions. This includes anything from cancer to pregnancy and will give young survivors the ability to get a job without risk of losing insurance coverage. Additionally, people will not be restricted to annual or lifetime limits, allowing young cancer survivors to face their survivorship without worrying about the financial ruin that may come with a recurrence.

Read more oncofertility coverage on the Affordable Care Act:

• Cancer and Health Care Reform
• New Changes in Health Care Reform Affect Oncofertility Patients