Category » Oncofertility

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.

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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.

 

Training the Next Generation in Oncofertility: Part I

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!

Oncofertility 101: A New Course in Emerging Fertility Preservation Techniques

By Francesca Duncan

Most cancer therapies, while life-preserving, can threaten the future fertility of both males and females.  Fortunately, the menu of fertility preservation options is broad, and due to ongoing research efforts through the Oncofertility Consortium and around the globe, these options are ever-expanding.  Hydrogel-based in vitro follicle growth is one such investigational technology developed by Oncofertility Consortium researchers in which immature follicles are isolated directly from ovarian tissue and grown in alginate, a natural biomaterial derived from algae.  This system supports follicular architecture through terminal stages of follicle development and has been shown in the mouse to produce eggs that give rise to healthy offspring.  Research is now focused on optimizing this system to produce live offspring in primate species.

As interest in learning and applying such technologies to the field of fertility preservation has increased, the Oncofertility Consortium launched a new course entitled: Oncofertility 101: a training course in in vitro follicle growth using alginate hydrogels.”  This is an intense one-day course in which participants experience  hands-on laboratory exercises aimed at learning the fundamentals of follicle micromanipulation, encapsulation, culture, and quality analysis.  This course “ensures that the transmission of technical skills needed to successfully grow healthy follicles in three dimensions are acquired quickly in order to advance the pace of reproductive research” emphasizes Teresa Woodruff, PhD, Director of the Oncofertility Consortium.  In addition to the laboratory exercises, Lonnie Shea, PhD and Min Xu, MD, PhD, both pioneers of this technology, present crucial insight into the evolution of follicle culture biomaterials and the ins and outs of setting up a follicle culture laboratory, respectively.  The course is led by Francesca Duncan, PhD, a Research Associate in the Woodruff Laboratory.

The first Oncofertility 101 course, held in September 2011, was very successful.  Participants came from diverse scientific backgrounds, including basic science, embryology, endocrinology, and biotech.  Participants found the course to be “excellent” and “a great opportunity.”  One person commented: “To really understand a technology I think you need to know how it is done so while I had read considerably about the technique, until yesterday, I did not have that important insight that goes with actually doing the technology… thank you for your time and effort and especially for your patience. It’s been twenty years since I actually sat at the bench and manipulated gametes!”

Oncofertility 101 is held twice a year, and the next course is right around the corner on Monday, March 12th.  This course is free of charge but registration is limited to five participants.  If you are interested in registering or would like more information, please click here.  The second 2012 Oncofertility 101 course will take place on Wednesday, September 26th, to coincide with the 2012 Oncofertility Consortium Conference.

 

 

Infertility Treatments and Ovarian Cancer: Results of a New Study

Last month, we wrote a series of blogs on Giuliana Rancic and the relationship between infertility treatments and breast cancer. A recent study has also raised awareness on such medical advances and the relationship with ovarian cancer. Ovarian cancer occurs in almost 4% of female cancer cases and is the leading cause of death from gynecological cancers.

In an article in the journal Human Reproduction, researchers compared the medical histories of approximately nineteen thousand women who had undergone in vitro fertilization (IVF) to treat infertility and compared them with another six thousand who had experienced infertility and did not undergo IVF. In order for a woman to go through IVF, she first stimulates her ovaries with high levels of hormones to produce multiple eggs from the ovaries, which are then removed and fertilized in a laboratory. In the study, the women who underwent IVF were found to have twice the rates of boarderline ovarian tumors that may or may not require surgery to treat. There were no differences in the overall rates of more advanced, invasive cancer between the two groups of women.

Interestingly, in the study, “Risk of borderline and invasive ovarian tumours after ovarian stimulation for in vitro fertilization in a large Dutch cohort,” the dose of hormonal stimulation or number of egg retrieval cycles did not seem to impact ovarian tumor risk. However, a significantly increased risk for ovarian tumor diagnosis occurred in the first year following stimulation, suggesting that hormonal stimulation may promote the growth of pre-existing ovarian tumors.

The authors note that while a difference was seen in the rate of boarderline ovarian tumors between women who underwent hormonal stimulation over those who didn’t, larger studies are required to determine what kinds of changes occur in the ovaries in response to hormonal stimulation and to examine the risk of invasive ovarian cancer compared to borderline ovarian tumors after IVF treatment. Additional factors also increase a woman’s risk of getting ovarian cancer, including genetics, personal history, increased age, hormone replacement therapy, and infertility itself. This information will aid patients and their clinicians in the decision-making process when deciding to participate in some fertility treatments.

The Role of OB/GYN in Comprehensive Cancer Care

What is the role of an obstetrician/gynecologist in cancer care for young women? When you think about cancer and cancer treatment, most likely you’re thinking of oncology and what line of defense will be taken against the cancer. A new article in Clinical Obstetrics and Gynecology from Oncofertility Consortium members, Betty Kong, BA, Robin Skory, BS, and Teresa K Woodruff, PhD, entitled “Creating a Continuum of Care: Integrating Obstetricians and Gynecologists in the Care of Young Cancer Patients,” argues that in some cases, the OB/GYN is the key component in this game.

Kong and Skory are both Woodruff Lab members pursuing dual MD/PhDs at Northwestern University, meaning they want to be involved in both the clinical and research aspects of oncofertility. Clearly they are invested in the scientific pathways oncofertility has to offer, but from a clinical perspective, they assert that obstetrician gynecologists are the best advocates for their patients to help them make informed decisions about their future fertility. According to the authors, “obstetricians and gynecologists [are] the primary physicians to many women during their reproductive years [thus] are in a unique position to be at the forefront of the oncofertility initiative by ensuring [they receive] the proper counseling, referrals, and continuity of care for their patients before, during, and after cancer treatment.”

For many young women, once they’ve reached the pinnacle of pediatric care (18yrs old), they are no longer regularly immersed in follow-up medical care as parents, schools, etc, require. Often the physician they see the most is their OB/GYN, whether it be for birth control options, pre natal care or their yearly exams. Many young women build long-standing patient/physician relationships with their OB/GYN as they did with their pediatricians. It is with this understanding that the authors claim the responsibility for the continuum of care falls upon the OB/GYN in many cases. Thus, the more informed they are in the field of oncofertility, the less patients will encounter a gap in their comprehensive cancer care, specifically in fertility preservation.

An OB/GYN is also in a key role should a cancer diagnosis present itself during a woman’s pregnancy. More studies need to be done on the long term affects of chemotherapy regimes on fetus development and future fertility, but there are treatments that women can undergo in their second and third trimester of pregnancy to try and eradicate the disease. According to the authors, “although it is an uncommon diagnosis, cancer during pregnancy presents a critical scenario that must be carefully treated by a multidisciplinary team of obstetrician gynecologists, medical oncologists, radiation oncologists, surgeons, pediatricians, genetic counselors, and patient navigators.” Again, as the multidisciplinary field of oncofertility develops, it is imperative that clinicians and scientists from diverse fields collaborate to provide patients with the best care possible and the most options for their future fertility.

To read the article, “Creating a Continuum of Care: Integrating Obstetricians and Gynecologists in the Care of Young Cancer Patients,” please click here.

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Egg Donation: To Pay or Not to Pay?

A recent blog post in the academic journal, Nature, explores a new report by the Nuffield Council on Bioethics (an organization in England that examines and reports on ethical issues in biology and medicine), suggesting that women who donate their unfertilized eggs to research deserve to be compensated. Currently in the United Kingdom, direct compensation for egg donation to research or for infertility treatments is prohibited by law. In the US, while direct compensation for egg donation to infertile couples/individuals varies by state, the only state that is allowed to use public funding to purchase unfertilized eggs for research purposes is New York.

The report argues that since egg donors are not compensated, researchers must rely on altruistic egg donors, which are few and far between. In a letter written to the academic journal Cell Stem Cell, scientists Kevin Eggan and Douglas Melton from Massachusetts discuss the issues they ran into when trying to recruit egg donors for a study they did in 2006-2007. They spent $100,000 on advertising over a 2-year period and although they initially received over 200 respondents, once they found out they would not be compensated, all but one dropped out of the study. Eggan and Melton’s findings suggest that if direct compensation for unfertilized eggs were legalized, more women would participate in egg donation for research purposes.

Ethical concerns and objections have been raised regarding egg donation, one in particular – the exploitation of the poor and disenfranchised. Some scholars and ethicists argue that if egg donation were monetized, it would lead to the comodification of the vulnerable, particularly poor and college-aged women. If a price tag were put on eggs, might a woman discount the burdens of submitting to egg stimulation and retrieval in exchange for the chance to earn $5,000 to $10,000, the going rate for eggs used in infertility treatments?

The flip side to this argument is that labeling this practice exploitative is overprotective and paternalistic. Why should egg donors for research be required to be more altruistic than those giving their eggs for reproductive purposes? Why compensate one for their time, burden, expenses and risks, but not the other?  Also, it is argued that there is a greater social value in donating eggs for research than there is in donating eggs for infertility treatments. Although at the Oncofertility Consortium, our scientists do not do research on donated eggs, they do study donated human ovarian tissue which is essential for advancing clinical practice in fertility preservation.

There are a number of arguments that can be made (and have been) for or against compensatory egg donation, but the fact remains that researchers residing in areas that compensate egg donors have higher participatory rates for their studies. This suggests that with the proper protocols in the place (i.e., a national registry which tracks egg donors limiting the amount of times they can donate, proportional and modest payments to egg donors, etc…), compensating egg donors for research studies may yield higher participation rates.

 

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Oncofertility Saturday Academy Pioneers Bioethics Education: Part 1

Recently there has been a lot of attention brought to the concept of collaboration in academia, specifically in the sciences. Gone are the days (at least in our niche) where disciplines drew a dividing line in the sand – scientists keep to one side of the room, humanities, you go play in the other corner, etc… We understand that there cannot be one without the other and the more we can begin to build a “common language,” the better off we will be as researchers, academics, students and all around everyday people.

One of the many areas that the Oncofertility Consortium has implemented a collaborative paradigm is in the Oncofertility Saturday Academies (OSA) held throughout the country. Young women in high school from diverse backgrounds are engaged in the basic sciences, the social sciences and the humanities. We open up our lab and say, “please come in, we’d like to show you what we’re doing and teach you how to be a better scientist too.”

Some areas we focus on in our Saturday Academy along with lab work are the ethical, social, legal and religious implications of oncofertility research. Dr. Laurie Zoloth, Oncofertility Consortium member and Professor of Medical Humanities and Bioethics at Northwestern University, has been a key component of the Ethics curriculum in OSA over the last 5 years.  According to Dr. Zoloth, “one of the most important things about doing research in reproductive health is thinking about the implications for human societies, human communities and the ethical implications that each individual faces.”

Dr. Zoloth and her students put together a 2-hour course for the young women, introducing them to basic definitions, theory and a case-based method of ethical decision-making in order to demonstrate the complicated and important questions that oncofertility raises. Dr. Zoloth says, “the attempt of our section is to broaden their understanding of the competing and sharply different moral arguments that attend to this research so that they know what the basic definitions, initial conversations, and arguments that have been made to objections raised from religion and moral philosophy are to this kind of research.”

At the Oncofertility Consortium, we believe that it is imperative that the future of science be a collaborative initiative and this is the basis through which we developed our national OSA program 5 years ago. According to Dr. Zoloth, “the complex decisions that are invoked by their [research] have to be apart of their science as well. So we teach [the girls] right along with the science, so they’ll understand how intertwined the work of a scientist is with the concerns of their society.”

Stay tuned for Part 2…

 

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Calling all Cancer Survivors to Evaluate Fertility Fact Sheets

The Oncofertility Consortium and the Hormone Foundation developed fact sheets for men, women, and children to learn about the impact of cancer on their fertility, hormonal management, and fertility options. These fact sheets are available at SaveMyFertility.org, a website which provides patients and providers with information about the reproductive health of cancer patients and survivors. They are offered for men, women, and children and come in both English and Spanish versions.

In an effort to evaluate the usefulness of the fertility preservation fact sheets, a new on-line survey is being conducted by Oncofertility Consortium members, Marla Clayman, PhD., and Sara Barnato, M.D., called,  “Evaluation by patients of the effectiveness of Fact Sheets developed to provide information on fertility preservation options and hormonal health after treatment.” They are evaluating the fact sheets in order to improve and expand upon them. All interested parties need to do is review a fact sheet in English or Spanish, and complete a short survey. Any cancer survivor age 18-44 may participate.

By participating in this new survey, survivors are not only helping themselves to better understand their cancer experiences but also potentially helping future patients. The more feedback oncofertility researchers receive, the better they are able to distinguish the impact these fact sheets have on cancer patients and survivors.

Interested survivors will be asked to read a Save My Fertility fact sheet, consent that they are between 18 and 44 years old, and complete a short survey. This short, on-line study makes it easy for cancer patients and survivors to help advance cancer research.  We are hopeful that we we’ll have at least 100 participants before the New Year, so please take the time to complete the survey before December 31st!

Learn more about this new survey.

 

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