Oncofertility is a multidisciplinary field requiring experts from a variety of different backgrounds including endocrinology, oncology, bioethics, urology, etc., in order to provide fertility options to cancer patients. In the oncofertility book series, each edition focuses on a specific component of oncofertility, with the 3rd book, Oncofertility Medical Practice: Clinical Issues and Implementation, addressing the clinical aspects of fertility preservation. The entire book culminates with a 15th chapter, “Clinical Cases in Oncofertility,” by Clarisa Gracia, MD, highlighting the most important concepts covered throughout the book through a series of case studies. Dr. Gracia states, “Because the number of complex fertility preservation cases at any single center may be limited, there is value in providing a series of cases from multiple contributors in this book.” Each oncofertility patient is different, stressing the importance of individualized care to minimize risks and maximize outcomes.
Often when discussing oncofertility, we are talking specifically about cancer patients; however, there are other diseases that may impact fertility. Dr. Gracia sites a specific case where an 8yr old pre-pubertal girl with a history of severe sickle cell disease was advised to pursue stem cell transplantation (SCT). Studies have shown that infertility and premature ovarian failure are potential risks of this procedure. Because of that, she was a good candidate for fertility preservation if her family chose to pursue that option. Due to her age, the only viable option for fertility preservation was ovarian tissue cryopreservation and after lengthy counseling sessions, her parents agreed to allow her to participate in this experimental procedure.
Dr. Gracia highlights 2 very important points this case brings into question about oncofertility. The first being that prepubertal girls have limited options for fertility preservation. Egg and/or embryo banking is not possible before puberty, and in this particular case, because the girl was not receiving pelvic radiation, she was not a good candidate for ovarian transposition. The second issue is that more and more cancer therapies are being used to treat non-malignant diseases. These patients are often very ill and can be at greater risk for fertility preservation complications. According to Dr. Gracia, in this case, “patients with sickle cell disease may be at higher risk of vaso-occlusive crises, thrombosis, and postoperative pain.”
Learn more about this and other unique oncofertility cases in, ”Clinical Cases in Oncofertility,” by Clarisa Gracia, MD, in Oncofertility Medical Practice: Clinical Issues and Implementation.