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Panel Discussion: Issues in Fertility Preservation


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The first Panel Discussion of the Conference was a well-attended discussion of issues in fertility preservation. The session was moderated by pediatric oncologists Dr. Yasmin Gosiengfiao of Lurie Children’s and Dr. Anna Franklin of MD Anderson, Olivia Jaworek Frias, RN patient navigator at Cincinnati Children’s and pediatric gynecologist Dr. Leslie Appiah of University of Kentucky. Drs. Gosiengfiao and Franklin reviewed clinical dilemmas and available treatment options in the difficult-to-treat prepubertal male population. Olivia Jaworek Frias shared her experience as a fertility navigator and outlined her key role in guiding patients through the complicated process of fertility preservation. Dr. Appiah discussed the special issues raised by a case of ovarian stimulation in an adolescent female with ovarian cancer, including how to calculate risk of ovarian failure, delay of chemotherapy for stimulation and risk of further delay in the instance of OHSS and how to assess the need for menstrual suppression and downregulation with GnRH during chemotherapy treatment.


Dr. Smith: Restoring Fertility in Males

SmithDr. Smith, a reproductive urologist at UCSF, educated us on the impact of cancer treatment on male fertility and the growing need for male oncofertility treatments as childhood cancer survival rates continues to increase. As has been a theme today, Dr. Smith reviewed how alkylating agents are associated with the highest risk of azoospermia. He then reviewed fertility preservation options, including current recommendations for referral to a specialist, sperm cryopreservation for post-pubertal males and/or testicular sperm extraction followed by IUI or IVF with or without ICSI. Dr. Smith concluded with a review of fertility preservation options in prepubertal boys: autologous spermatogonial stem cell transplantation and in vitro maturation of spermatogonia, both of which are experimental.

Dr. Campo-Engelstein: Ethical Considerations in Adolescents

CampoDr. Campo-Engelstein, PhD in bioethics at Albany Medical College, gave a compelling review of the key ethical considerations in ovarian stimulation in adolescent cancer patients. She led attendees through a range of topics and emphasized how the biologically-determined differences in treatment by sex have real ethical ramifications for providers. Dr. Campo-Engelstein highlighted sex-determined differences in treatment, including higher cost and societal pressures for females, and the concept of bodily invasion related to invasive fertility preservation treatments in peripubertal patients. She ended with a goad to action encouraging providers to engage adolescent patients in distinct, sex-specific conversations.

Dr. Su: Ovarian Stimulation in Adolescents

Su, UCSDDr. Su, of UCSD, gave an eloquent and stimulating lecture reviewing medical considerations in adolescents undergoing controlled ovarian stimulation for fertility preservation. Mature oocyte and embryo cryopreservation are established fertility preservation methods associated with high success rates. Dr. Su discussed how results of a case series demonstrating MII oocytes from premenarchal girls suggest that maturation of the hypothalamic-pituitary-ovarian axis may not be required for ovarian stimulation, though studies have not demonstrated live births following stimulation in premenarchal girls. Optimal treatment protocols and retrieval procedures differ in post-menarchal adolescents compared to infertile adult women. For example, adolescents should undergo abdominal ultrasounds with a full bladder, require different pre-treatment, stimulation and trigger protcols and may require overnight stays following retrievals.

Dr. Sklar: Outcomes in Childhood Cancer Survivors


Dr. Sklar, Pediatric Endocrinologist, Survivorship expert and Director of the Long-term Follow-up program at Memorial Sloan Kettering, provided the morning keynote address and the first clinical lecture of the Consortium. He reviewed how long-term outcomes are highly dependent on both treatment (e.g. radiation vs. chemotherapy) and demographic characteristics like age and biological sex. Attendees learned that endocrine complications are most common in survivors treated with high-dose alkylating agents, such as that used in patients undergoing auto- and allo-stem cell-transplants with chemotherapy-alone protocols, and in survivors treated with radiation to the head, neck or pelvis. The impact of radiation is both dose and time-dependent and relatively low doses of radiation, 18 Gy, have been associated with precocious puberty and growth hormone deficiency.

Dr. Clark: Female Germ Cells Differentiation


Dr. Amander Clark of UCLA reviewed how differentiation of germ cells can be achieved from induced pluripotent stem cells (IPS). She reviewed how cells from the inner cell mass develop into the epiblast, which develop into all somatic cells including the primordial germ cell which differentiates into oogonia-> oocytes. Studies in their laboratory demonstrate that day 3 primordial germ cell-like cells (PGCLCs) in reconstituted ovaries can initiate meiosis. She then reviewed their procedure for identifying human primordial germ cells and outlined the next frontier: differentiating human primordial germ cells into oogonia.

Sponsor Highlight: Robert H. Lurie Comprehensive Cancer Center

The Oncofertility Consortium is so lucky to have the support of a number of sponsors for our upcoming Oncofertility Conference, Critical Conversations in Oncofertility: Pediatrics and Beyond.

Today, we’d like to highlight the Robert H. Lurie Comprehensive Cancer Center for their generous sponsorship.  The funds provided by the Robert H. Lurie Comprehensive Cancer Center allowed us to expand the format of this year’s conference to 2 full days of lectures and panel sessions and ensure the participation of high caliber speakers you have all come to expect from this annual symposium.  We thank them for their consistent support and collaboration!



Oncofertility in the news!

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The Chicago Tribune recently published an article, Kids with Cancer get Futuristic Chance at Saving Fertility, describing the role of ovarian and testicular freezing in saving future fertility for pediatric cancer patients.  The article highlighted patient and parent stories from Ann & Robert H. Lurie Children’s Hospital in Chicago, IL.

While the decision can be overwhelming for all patients considering fertility preservation options in the face of a cancer diagnosis, it is even more challenging for parents making the decision on their child’s behalf.  However, parents interviewed for the article outlined that they feel better knowing that they’ve done what they can to preserve the option for their child if they elect to have a fmaily in the future.

Read more HERE


Moving Beyond Cancer

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The Oncofertility Consortium was highlighted in the Spring 2015 issue of Northwestern Medicine Magazine in the article “Moving Beyond Cancer“.  In this issue, Holly and Richard Manprisio, and their journey to build a family, are highlighted.  Holly conquered stage 4 Hodgkins lymphoma when she was just 13 and was followed closely by the STAR Survivorship Program at Ann & Robert H. Lurie Children’s Hospital.  At age 28 she was faced with a breast cancer diagnosis and was able to bank eggs before undergoing chemotherapy, radiation, and further treatment with Tamoxifen.  Happily, Holly and Richard have welcomed twin boys, Ethan and Benjamin into the world thanks to the Oncofertility Consortium, Ann & Robert H. Lurie Children’s HospitalSTAR Program and Northwestern Medicine!



Dr. Woodruff featured in Evidence-Based Oncology Journal

Dr. Woodruff was featured in a recent article in Evidence-Based Oncology. Read the article below:

Fertility Preservation in Young Cancer Patients

Published Online: November 17, 2014
Surabhi Dangi-Garimella, PhD

Advanced diagnostic tools and innovative treatment measures in cancer have increased cancer survival rates in the United States. Efforts by the various stakeholders in the drug development process—research scientists, the pharmaceutical industry, the FDA—resulted in the approval of 6 new anticancer agents over a 1-year period ending July 31, 2014, according to the 2014 Progress Report by the American Association for Cancer Research. Additionally, 5 previously approved agents were endorsed for alternate indications.1Along with increased incidence, there has been a significant increase in the number of cancer survivors. While the United States had an estimated 3 million survivors in 1971, that estimate is expected to reach about 14.5 million in 2014, with nearly 380,000 having been diagnosed as children or adolescents.1 One issue that plagues cancer survivors is quality of life, which could stem from either emotional or physical problems, or a combination of the two. Infertility is a major concern: irradiation of the testes or a regimen that includes chemotherapy, especially alkylating agents, can reduce fertility.

To read the rest of the article, please click here.

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