Category » Fertility Preservation

Ovarian Tissue Induces Puberty After Stem-Cell Transplantation

We often discuss the many ways young people can preserve their fertility prior to undergoing medical procedures that may leave them sterile. One of these fertility preservation options, ovarian tissue cryopreservation, or freezing, has recently been reported in the Lancet medical journal, to also successfully be used to induce puberty in a 13 year old girl who had undergone a stem-cell transplant.

The authors of the study, Poirot, Abirached, Prades, Coussieu, Bernaudin, and Piver, report the case of a young girl with severe sickle-cell anemia. Sickle-cell anemia, or disease, is a recessive genetic disorder that causes the red blood cells to take on an abnormal “sickle” shape, which can cause reduced hemoglobin (carries oxygen to the bodily organs) and decreased blood flow. Sickle-cell disease can cause variety of symptoms including swelling of the digits, fever, chest pain, difficult breathing, and premature death.

In the case, a young girl’s sickle cell disease was so severe that she chose to undergo stem-cell transplantation. Prior to transplantation, patients may undergo total body irradiation or high levels of chemotherapy, which can often destroy their fertility, before the infusion of donor stem cells that may cure their disease. Before undergoing the irradiation, the 10-year old girl had one of her ovaries removed through a laparoscopic procedure, dissected into 23 pieces, and then frozen.

Three years later, at age 13, the girl returned to her clinicians with a problem. She had not yet shown evidence of entering puberty. The doctors then reimplanted 3 thawed pieces of her ovarian tissue in an attempt to induce puberty. Within two months, she started to develop breasts and pubic hair, and eight months after the graft, the girl had her first period. This is the first published report of ovarian tissue reimplantation for the express purpose of inducing puberty.

It is important to note a few things in this case. First of all, the clinicians in the case implanted the ovarian tissue in the abdomen, not in the normal location of the ovary, as the purpose was to induce puberty, not pregnancy. Secondly, though the procedure was a success, the girl’s menstrual cycles continued normally only for about two years and became irregular afterward. Thus, if she wishes to become pregnant later in life she may need to reimplant some of her remaining  ovarian tissue. Further effort by oncofertility researchers will be needed to 1) determine if ovarian tissue can reliably induce puberty in girls, 2) understand how ovarian tissue can be used to grow ovarian follicles in vitro, and 3) develop stem cell and cancer treatments that do not impact the hormonal health and reproductive potential of children.

2012 Chicago Oncofertility Saturday Academy at Northwestern University is Another Great Success!

By Nadia Johnson, Co-Director of the Oncofertility Saturday Academy

On Saturday, February 18th, 31 high school girls hailing from six different local Chicago high schools celebrated the culmination of the sixth annual Oncofertility Saturday Academy (OSA) with a family day and graduation event. OSA is the flagship academy of the Women’s Health Science Program, the award-winning science education program that aims to inspire high school girls from traditionally underrepresented backgrounds to pursue careers in science and medicine. OSA consists of a junior academy (JOSA) geared toward laboratory sciences, and a senior academy (SOSA) geared toward clinical sciences. Each academy includes weekly homework assignments, and three on-campus days filled with hands-on laboratory or clinical activities, workshops on such topics as sexual health and applying to medical school, and panel discussions with students or professionals in the field.

During family day, students demonstrate how much they have learned during the five-week program by presenting a capstone project, and rotating through stations that cover some of the academy topics with their families. For example, the SOSA students take their parents’ blood pressure (a skill they learned during the “Doctor for a Day” session) and the JOSA students show their parents how female fertility can be preserved through the use of follicle isolation and preservation in alginate beads (a technique pioneered by the Woodruff and Shea labs, that they learn about during the “Regulation of Ovarian Function” session).

Graduation follows family day, and is a chance for everyone – parents, siblings, and friends of the OSA students, and the over 100 OSA volunteers – to celebrate the accomplishments of the girls who were motivated and dedicated enough to complete homework assignments every week, and get up extra early on Saturdays to attend the on-campus all-day sessions. Each student gives a short speech before accepting her certificate and OSA patch. One student, a senior at Roberto Clemente High School, started her speech with: “I am very honored to be part of this program, this is the first year that it was opened to Chicago Public Schools [so] I am fortunate to be here.” Up until this year, the OSA program was only available to students from the Young Women’s Leadership Charter School. With the help of many teachers and advisors throughout the Chicago Public School system, the program leaders were able to offer the program to other qualified students this year; in addition to Clemente and Young Women’s, OSA student hailed from four other schools: Kenwood Academy, King College Prep, Lindblom Math and Science Academy, and Instituto Health and Science Career Academy.

Many other students commented on their favorite experiences during the academy in their graduation speeches. Several SOSA students remarked that using the da Vinci surgical robot, a $1.5 million system used for minimally invasive gynecologic procedures, during the “Oncofertility & Surgery” session, was their favorite part of OSA. Most of the students thanked their mentors – JOSA girls were partnered with scientist mentors and SOSA girls we paired with first year medical students. The girls were proud of what they had accomplished, and recounted their experiences during the program with a mixture of gratitude and amazement. One student, a senior at Young Women’s Leadership Charter School, concluded her graduation speech with a quote from author Sarah Caldwell: “Learn everything you can, anytime you can, from anyone you can – There will always come a time in your life, when you will be grateful that you did.”

It may appear that the OSA program is designed to teach high school girls about cancer, reproductive biology, and oncofertility, but the program strives to teach so much more than that. It is a program designed to empower young women with knowledge about their own bodies; a program with over 100 university staff, student, and faculty volunteers, who serve as role models and mentors during the program; a program looking to change the face of science and medicine. OSA is a program that takes young women who are willing to learn, and hopes to turn them into the scientists, physicians and leaders of tomorrow.

 

Oregon Science Academy Graduates with Honors in Fertility Preservation

It’s only March and two of the Oncofertility Saturday Academies (OSA) have already completed their graduation ceremonies. With this newest class, the Oncofertility Saturday Academies have educated more than 240 students across the US. Last weekend, Mary Zelinski, PhD, who heads one of the Oncofertility Consortium‘s research projects, wrapped up this year’s Oregon academy at the Oregon Primate Research Center (ONPRC). Here’s what she had to say:

———————————————————————————————————-

By Mary Zelinski, PhD

The Oncofertility Saturday Academy held at the Oregon National Primate Research Center and Oregon Health & Science University graduated on February 25, 2012.  The students celebrated their accomplishments by sharing outstanding posters, delicious pizza and interesting views on some ethical issues involving this rapidly evolving field.  Ten high school students from the Portland metropolitan area met for six consecutive Saturdays to learn about the field of Oncofertility through hands-on labs and lectures.  This year, we even had the sister of one the students in our first ‘official’ Oregon OSA graduating class!

On our first day of class, each student was assigned a cancer patient needing information and guidance about their fertility, and by the final class, the students shared their recommendations for fertility preservation options specific to their individual patient. Another highlight of the graduating class was a morning of very moving presentations by young cancer patients, both of whom had been recently diagnosed, and their quest to preserve their fertility.  This really put the entire content of the class into a real-life context for the students.

The Oregon OSA was again a big success, thanks to the efforts of Diana Gordon, Director of Education Outreach at ONPRC, Mary Zelinski, Associate Scientist at ONPRC and class instructor, Lynda Jones, Oregon OSA Curriculum Development Coordinator, and Dr. David Lee, Department of Obstetrics & Gynecology, OHSU.  Here are some student comments:

“We were trusted to do real experiments and really got to dig deeper into current research about oncofertility.”

“I really enjoyed being able to participate in hands-on experiments and explore a field that is relatively new in science.”

“I loved talking to Dr. Lee and the cancer patients, and I loved ultrasounding the monkey.  I would make there be an Oncofertilty II class that I could take!”

“The hands-on labs and interactive parts (like the suture lab…) were FANTASTIC!”

“I liked the size of the class, the opportunities given by the instructor were unique, and I absolutely loved all the activities we did in class.”

“So much fun, amazing instructors!”

We will look forward to continuing Oregon OSA for as long as we can.  Our future efforts are aimed at polishing our curriculum that is using Oncology/Cancer as well as Oncofertility as major themes, training area high school teachers in using this curriculum, and basically disseminating these classes and labs (including those in NUBIO) throughout the Portland area.

Congratulations to all current and future OSA alumni !

 

 

Survivors: A New Magazine for Breast Cancer Survivors

As we have covered in past blogs,  young people account for about 10% of all cancer patients.  As science, research and advocacy evolve, more young people are SURVIVING cancer and going on to lead healthy and productive lives. Nonetheless, young cancer survivors are in a league of their own when it comes to survivorship issues, (i.e., late-term effects of cancer treatment, fertility, heart & brain health, etc…). In an effort to address and celebrate breast cancer survivorship, particularly in women diagnosed at a young age, a new quarterly magazine was born: Survivors: A Magazine for Inspiration, Hope, Healing and More.

In November 2011, the premier issue of Survivors: A Magazine for inspiration, Hope, Healing and More was published. According to the editors, the goal of the magazine is to “highlight positive and inspiring breast cancer survivor stories – about people who have turned their diagnosis and situation into possibilities and opportunities.” The most significant aspect of this new magazine lies not only in its mission, but also in its content – the magazine spotlights grass roots programs and organizations allowing them to get the kind of exposure they often deserve and need, but don’t often get.

Throughout the first issue are stories from women, many still in their reproductive years, who are involved with the Breast Cancer Awareness Body Painting Project (BCAPP). BCAPP is a form of art therapy for breast cancer survivor showcasing women of all different races and ethnicities with their chests/torso painted, aiming to demonstrate the beauty and inspiration in survivorship by presenting a positive body image of breast cancer survivors. If you have not already, you should definitely take a look at these profound and brave images of women who have been diagnosed with and survived, breast cancer.  If you need a little inspiration, you will be hard pressed not to find it here.

Their first issue of Survivors: A Magazine for Inspiration, Hope, Healing and More can be downloaded for free so take a look at it here and if you love it, they’ve already released their second issue for purchase.  If you’re interested in contributing breast cancer survivor stories or other related content, please send them an email at: survivors@inkspotdesigns.com.

 

Oncofertility Consortium at Northwestern University Pioneers Fertility Preservation

Fertility sparing procedures which were once infrequent and under utilized, are now more commonly performed in young men and women facing a cancer diagnosis. A recent article in the February issue of the American College of Surgeons Bulletin, entitled Gynecologic Oncology Surgeons Spare Patients’ Fertility, Enhance Quality of Life,” by Jeannie Glickson discusses some of the technological advances in gynecologic oncology which have produced more favorable outcomes for young people facing a cancer diagnosis and fertility loss. Glickson talks to several heavy hitters in fertility preservation care, including Kristin Smith, Fertility Preservation Patient Navigator, and Oncofertility Consortium member Dr. Julian Schink, who maintain that it takes a multidisciplinary approach and team effort to treat young cancer patients.

One of the many things that Northwestern University is known for is pioneering collaborative fertility preservation care, oncofertility, at a time when many other institutions were treating fertility loss as a side effect of cancer treatment. According to Dr. Schink, “You need an oncologist who believes that the patients’ survival is the first priority, and you need a fertility team that respects some cancer patients’ desires to have children. You need strong players on both sides.” Specifically for these reasons, the Oncofertility Consortium was established – to respond to an urgent need for comprehensive fertility preservation care, incorporating clinicians, researchers and social scientists, all committed to ensuring that patients understand and can utilize fertility sparing technology.

Currently, patients interested in preserving their fertility may have some options that coincide with their cancer care, but other techniques not yet available to patients are being researched at the Oncofertility Consortium for potential future use. One of these techniques, a process called in vitro maturation, is performed by harvesting immature eggs from ovarian tissue strips which are cultured outside of the mother’s womb, treated with hormones until they mature and then fertilized with sperm to create an embryo. This would be particularly useful to patients who are not candidates for ovarian tissue transplantation such as leukemia patients or those with ovarian cancer.

As a result of the efforts of the Oncofertility Consortium and its members, patients can now receive comprehensive fertility preservation care at several sites across the country and internationally. At Northwestern, there has been a slight decline in the demand for fertility preservation services because patients no longer need to travel to Chicago for their treatment – they can find an institution, with the help of our Fertility Preservation Patient Navigator, in their own areas and according to Dr. Schink, “that’s a good thing.”

To read more about Northwestern’s pioneering efforts in oncofertility in Gynecologic Oncology Surgeons Spare Patients’ Fertility, Enhance Quality of Life, please click here.

Cancer & Fertility Preservation: How I Lost My Uterus and Found My Voice

A newly released memoir from cancer survivor, Michelle Whitlock, delves into her experiences with HPV, cervical cancer, fertility preservation and love in a book that you will read from start to finish in one sitting. How I Lost My Uterus and Found My Voice is an honest and (very) candid account of what her 20s looked like, replete with all the things you might expect out of a 20 something: falling in love, travel, finding oneself, heartbreak, etc… Now throw in a whole lot of cancer, embryo banking, chemo, radiation, incontinence and a play by play of “getting your groove” back after your vagina has done a total 180 from what it once was, and you have a very unique story.

At the age of 26, Michelle found out that she had HPV, a sexually transmitted virus infecting 50-60% of sexually active people. Shortly after finding this out, she received the biggest blow of her life – she was diagnosed with invasive cervical cancer.   From that point forward, Michelle made it her mission to ensure her treatment plan was something that worked for her, meaning not only was she going to do everything in her power to beat the cancer, but she was also going to fight just as hard to preserve her fertility for her “maybe babies” one day. At a time when little information was offered regarding fertility preservation, Michelle had to take the reins into her own hands and become her best advocate. Unsure of whether or not she even wanted children, she was not going to let cancer take her options away.

After successfully beating cancer the first time around and avoiding a total hysterectomy by electing to undergo an experimental surgery to eradicate the disease, she was diagnosed with the same cancer just a few years later.  She was left with no other option except chemo, radiation and a total hysterectomy, but as a result of her research and commitment to finding the best care possible, she found a doctor who understood the importance of her fertility just as much as she did. Thus, her “maybe babies” came to fruition and were put on ice for a date… TBD.

I don’t want to giveaway any more of her story, but this is a must read for cancer patients, survivors, caregivers or anyone that wants to know what cancer, fertility issues, and sexuality really look like. I highly recommend it for its rawness and the openness with which she shares her experience. Nothing is sugar-coated in these pages – Michelle talks about things that will make you blush from time to time, but they’re the things no one talks about, and should be.  It’s an inspirational story that reads like a conversation with your girlfriends so if you haven’t already, please pick up a copy of How I Lost My Uterus and Found My Voice, by Michelle Whitlock, and see what I have been raving about!

Fertility Preservation, Parenthood and Collaborative Care

A new journal article by Oncofertility Consortium members explores the fertility and parenthood concerns of adolescent and young adult (AYA) female cancer survivors and the various components that lead to their reproductive decisions. The qualitative study that begot this article aimed to provide additional insight into how AYA survivors make fertility and parenthood decisions and what barriers they face along they way. “How Do You Feel About Fertility and Parenthood? The Voices of Young Female Cancer Survivors,” by oncofertility researchers Jessica R. Gorman, Samantha Baily, John P Pierce and Irene Su in the Journal of Cancer Survivorship, presents in depth information on an issue that has not been thoroughly explored in existing scholarship.

Six themes emerged from the analysis of the data gathered from study participants: (1) A hopeful but worried approach to fertility and parenthood, (2) Frustration with a lack of choice or control over fertility, (3) Young survivors want information about their fertility, (4) Young survivors want better continuity of care in survivorship, (5) Cancer diagnosis and related fertility problems introduce relationship challenges, and (6) Decisions about parenthood are complicated.[1]

The overriding theme of this study and something the Oncofertility Consortium is working tirelessly to improve, is the importance of collaborative, comprehensive medical care for young cancer patients. Study participants described feeling disappointed with the care they received as patients and the lack of coordination among providers treating them.  Specifically for patients experiencing long-term side effects such as the loss of fertility, much of the burden of managing their care fell onto them as their providers focused on their immediate need for treatment and did not discuss at length or in some cases, at all, potential long term consequences of treatment. These findings are consistent with previous research suggesting that there is an unmet need for fertility preservation counseling at the time of diagnosis.

Understanding the concerns of young cancer survivors is the first step toward developing an effective and appropriate treatment plan that is consistent with the needs of the AYA population. As we now know, the AYA cancer community presents its own set of unique challenges when devising a comprehensive treatment regime. Collaboration among health care providers is an important step toward improving the quality of care from cancer patient to cancer survivor. Click here to read, “How Do You Feel About Fertility and Parenthood? The Voices of Young Female Cancer Survivors.”


[1] Gorman, J, Bailey S, Pierce JP, Su HI. Journal of Cancer Survivorship. 2011, Dec 17.

Grand Rounds at the University of Illinois at Chicago: Legal and Ethical Implications of Fertility Preservation

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!

Training the Next Generation in Oncofertility: Part 3

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 2nd 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.”

Factors Affecting Fertility Preservation: A New Study

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.

 

Page 13 of 24« First...1112131415...20...Last »
© Oncofertility Consortium Blog