Research Update: New Insights into use of Ovarian Tissue After Cryopreservation

Two ovarian follicles at different stages of maturation (primary on the left, secondary on the right).

Two ovarian follicles at different stages of maturation (primary on the left, secondary on the right).

Women with ovarian lesions, such as benign or malignant tumors, or those at high risk for breast or ovarian cancer now have additional evidence that can help them decide if they would like to preserve their fertility and how. Ovarian tissue cryopreservation is an experimental fertility preservation option that may be an alternative to more established options such as oocyte and embryo banking. Ovarian tissue cryopreservation includes the surgical removal and freezing of the ovarian cortex, which contains ovarian follicles and it’s immature eggs. After later thawing, this tissue may be transplanted back into a woman once she is ready to have biological children.

Some women, such as those with ovarian tumors or with a high risk of ovarian cancer may not be candidates for this ovarian tissue transplantation. Thus, researchers at the Oncofertility Consortium are investigating the ability to mature ovarian follicles in the laboratory setting until they are able undergo in vitro fertilization (IVF).  One remaining question in oncofertility research is whether ovaries with lesions have reduced numbers of follicles, which may impact the ability to have biological children through these techniques. The paper, “Human Ovarian Tissue Cortex Surrounding Benign and Malignant Lesions,” addresses this question by examining follicle numbers in the ovarian tissue of more than 130 women.

In the article, National Physicians Cooperative (NPC) Co-director Mary Ellen Pavone MD, MSCI; NPC member, Jennifer Hirshfeld-Cytron, MD, MSCI; Oncofertility Consortium Director, Teresa K. Woodruff, PhD, and others, determined that follicle density is affected in woman with specific types of ovarian. Those with benign ovarian masses had the statistically similar number of follicles as those with physiologically normal ovaries. In contrast, women with ovarian cancer and those with a strong family history of breast or ovarian cancer had significantly reduced follicle density, although follicles were still seen in most of these tissues.

These findings, available in the journal, Reproductive Sciences, may provide fertility preservation guidance for women with ovarian lesions, and those with a strong family history of breast cancer. The authors discuss that health care providers may counsel women with benign ovarian lesions about preserving fertility with ovarian tissue cryopreservation, to be followed by either retransplantation or in vitro maturation of follicles. In contrast, providers may indicate to women with malignant cancers and those with familial breast or ovarian cancer that they may not be ideal candidates for fertility preservation, due to the reduced ovarian follicles in these tissues.

Given the new study and individual considerations for young women, each patient should discuss 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).

Support The Family Act of 2013!

Imagine that you are diagnosed with cancer at 24.  On top of processing the enormity of your diagnosis at such a young age, you’re shuttled from one appointment to the next, coordinating your treatment plan in the quickest timeframe possible.  Today, treatment discussions are more frequently including information regarding fertility preservation measures which gives hope to many patients about to start their arduous cancer treatment.

Screen shot 2013-10-02 at 3.38.23 PMUnfortunately, this hope can be short lived once patients learn that fertility preservation services are not typically covered by insurance and need to be paid out-of-pocket.  Out-of-pocket, in this case, can mean a few hundred dollars for sperm banking for male cancer patients or thousands of dollars for female patients.  Fortunately, there is help on the horizon.

The Family Act of 2013 has been introduced into both the U.S. Senate and U.S.House of Representatives (S 881/HR 1851) and will provide critical financial support for young people with cancer, autoimmune disorders, and other conditions whose treatment may save their lives yet damage their ability to have children in the future.  Modeled on the existing Adoption Tax Credit (ATC), The Family Act will create a tax credit for eligible taxpayers to cover 50% of the cost of IVF and fertility preservation up to the maximum amount of the credit set by the ATC ($12,970 this calendar year).

Many professional groups (for example: American Society for Clinical Oncology, Association of Pediatric Hematology/Oncology Nurses) support and recommend fertility preservation discussions with patients prior to treatment but the cost is frequently not covered by health insurance.  This financial impact often inhibits young people from undergoing such preventative measures.  Without financial assistance for these services, patients may elect to forgo fertility preservation prior to treatment, which may result in inflated costs for the survivor and the health care system years later when trying to build a family.

The Oncofertility Consortium supports The Family Act of 2013 as it will improve the lives of patients dealing with cancer and other serious, life-threatening diseases.  We fully understand the need to provide financial support for fertility preservation for young patients prior to damaging treatments.

You can read a copy of the bill here: The Family Act of 2013 – bill

Send letters of support to your congressmen here: Letters to Senate and House of Representatives

Until The Family Act of 2013 becomes a law (must be approved by both chambers by December 2014 to do so), consider utilizing our billing templates to help navigate insurance coverage in this patient population: Oncofertility Consortium billing templates

Research Update: First Live Human Birth From Vitrified Ovarian Tissue

PNASThe reproductive community took note recently with the publication of research stating that ovarian tissue cryopreserved using a technique called vitrification, has resulted in a live human birth. Ovarian tissue cryopreservation is an experimental fertility preservation technique that involves the surgical removal of an ovary, freezing, and later thawing and transplantation when the woman is ready to have children. This technique is an option for women and girls who may not be able to undergo more established fertility preservation options but to-date only about 20 human live births have been reported using this technique.

All of the live births from frozen and thawed ovarian tissue were cryopreserved using a slow-freezing method but the recently reported birth came from tissue that was vitrified, which is a specialized fast-freezing method of cryopreservation. Vitrification has been used to significantly increase the success rates of oocyte (egg) banking over the past decade.

Ovarian tissue cryopreservation is a fertility preservation option for women and girls who may loose their fertility due to cancer treatments or disorders such as primary ovarian insufficiency. Patient 3 in the article, “Hippo signaling disruption and Akt stimulation of ovarian follicles for infertility treatment,” underwent removal of both ovaries at age 29 after losing her menstrual cycles at age 25. The ovarian cortices were dissected and vitrified. The article, published in the journal, Proceedings of the National Academy of Sciences (PNAS), describes how the tissue was processed with fragmentation into smaller cubes and treated with a set of drugs designed to stimulate the growth of ovarian follicles.

Between 40 to 80 cubes of ovarian tissue (1-2 mm2 each) were autotransplanted back to the patient via surgical placement into the oviductal serosa (the outer layer of the fallopian tube).  Estradiol levels were monitored to assess when the transplanted tissue contained functional follicles, the patient was given exogenous follicle stimulating hormone (FSH) with subsequent ultrasound to monitor growth of mature antral follicles, followed by human chorionic gonadotropin (hCG) treatment. Six oocytes were retrieved and then fertilized with her husband’s sperm using intracytoplasmic sperm injection resulting in four embryos, two of which were transferred to the patient’s uterus. Thirty-seven weeks and two days later a healthy baby boy was born.

According to Mary Zelinski, PhD, and Associate Scientist in the Division of Reproductive & Developmental Sciences at Oregon National Primate Research Center of Oregon Health & Science University, “The exciting finding is that this is the first demonstration of a live human birth from vitrified (not slow-frozen) ovarian cortical tissue after transplantation, intra-cytoplasmic sperm injection of retrieved oocytes and embryo transfer.”

While this moves the field of reproductive research forward, there is still significant work needed to improve ovarian tissue cryopreservation success rates for both slow-frozen and vitrified tissue. For example, in the current study, 27 patients received similar treatments, eight had evidence of antral follicle growth and oocytes were retrieved, but only one gave birth. In order for next-generation technologies like ovarian tissue cryopreservation to become established treatments, further research is needed to improve success rates and ensure the health of children born from such treatments. To see more information about this research, watch one of the study researchers, Nao Suzuki, PhD, discuss it at the 2013 Oncofertility Conference.

Perspectives from the 7th annual Oncofertility Conference

Screen shot 2013-09-26 at 3.04.58 PMOncofertility is a multidisciplinary field of experts coming together to provide fertility options to cancer patients.  The multidisciplinary nature of the field was on display during our 7th annual Oncofertility Conference in Chicago, Illinois.  During the course of the conference, we saw presentations from international scientists, Northwestern program leaders, social workers, surgeons and reproductive endocrinologists (to name a few). In addition to the powerhouse lineup of speakers, conference attendees were able to interact amongst themselves to foster collaborations to begin, or strengthen, their individual fertility preservation programs.  The audience was just as diverse with cancer survivors, high school students, patient advocates and navigators, lab scientists, physicians and community leaders coming together to share stories and gather data to better serve their patients at home.  They also had the opportunity to attend our largest poster session to date with 50 scientific posters from around the world demonstrating current advances in oncofertility.

As the new research project coordinator for the National Physicians Cooperative (NPC) of the Oncofertility Consortium, I considered the conference my initiation into the oncofertility community.  During my first few weeks at Northwestern, while being oriented to a new field at a new institution, I spent a large part of my day reviewing scientific papers, watching Virtual Grand Rounds, and thumbing through book chapters to try and grasp the intricacies of oncofertility.  While that process gave me a fairly comprehensive understanding of the mechanisms behind fertility preservation issues in current cancer patients and survivors, the true importance of the work being done by the Oncofertility Consortium really hit home when I had a chance to speak with conference attendees.

I spoke with cancer survivors on what these fertility preservation measures mean to them and their future reproductive options.  I chatted with patient advocates and nurses about the issues that patients discuss with them on a daily basis and then viewed presentations from respected leaders on methods and techniques to address those issues.  I met national NPC leaders who discussed current protocols and clinical standards before brainstorming ways to improve the standards and create solutions for roadblocks.

While members of the Oncofertility Consortium, and the broader oncofertility community, come from different backgrounds and geographical locations, we are working towards a shared goal of expanding fertility options for cancer patients and survivors.  I look forward to establishing my role in the National Physicians Cooperative of the Oncofertility Consortium and collaborating with members across the country.

I invite you to view the 7th annual Oncofertility Conference here:  2013 Oncofertility Conference

First Conference of Society for Adolescent and Young Adult Oncology

Screen Shot 2013-09-16 at 1.48.31 PMThe Society for Adolescent and Young Adult Oncology was founded to engage professionals who are dedicated to improving adolescent and young adult cancer care across the world. It promotes interdisciplinary research, education, and collaboration in order to advance understanding of the unique biology and treatment needs, such as fertility management, of adolescent and young adult (age 15 – 39) cancer patients. Under the helm of Leonard Sender, MD, the society and its partner Journal of Adolescent and Young Adult Oncology have begun raising awareness of these critical needs and are proud to announce their first-ever meeting on October 16-17, 2013.

This first meeting at the University of California, Irvine, will include discussions on many of the critical issues in adolescent and young adult (AYA) oncology, such as the importance of prevention and early diagnosis in young patients. Considerations for the periods after diagnosis will also be discussed including fertility planning by clinician and oncofertility champion, Laxmi Kondapalli, MD, who will host a seminar on Eliminating Oncofertility: Reducing Fertility Risks in Cancer Patients. Rebecca Block, MSW, PhD, who recently presented her research at the 2013 Oncofertility Conference, will also discuss her fertility preservation decision tool for young women.

In this time of health care change, the meeting will critically include discussions of the role of AYA advocacy and legal issues in oncology care. Such speakers will include Matthew Zachary, from young adult advocacy organization Stupid Cancer, and Monica Bryant, Esq. from Triage Cancer. In addition, the keynote seminar will include information on the next-generation of health record ownership. Ryan Panchadsaram, a Senior Advisor in the Office of Science and Technology Policy at the White House, will discuss the much-awaited Blue Button project, to empower patients with access to their own medical records.

Together, this impassioned group of professionals and advocates at the first conference will raise the bar for research and treatment in AYA oncology. We look forward to hearing their insights.




President-Elect of the American Medical Association To Speak at the 2013 Oncofertility Conference

Dr. WahThe Oncofertility Consortium is proud to announce that Robert M. Wah, MD, reproductive endocrinologist, ob-gyn, and president- elect of the American Medical Association (AMA), will be speaking at the 2013 Oncofertility Conference on the evening of September 9th. Dr. Wah practices and teaches at the Walter Reed National Military Center in Bethesda, MD, and the National Institutes of Health. As division head and vice chairman of the Navy’s largest ob-gyn training program, Dr. Wah was voted Teacher of the Year by his residents, and his group started the first military IVF program on the West Coast. He has served on the faculties of the Harvard Medical School, the University of California, San Diego, and the Uniformed Services University of the Health Sciences. A member of the AMA House of Delegates for 17 years, Dr. Wah has served as chair of the AMA Council on Long Range Planning and Development. He was elected national chairman of the Junior Fellows of the American College of Obstetricians and Gynecologists (ACOG), before being elected chair of the AMA Young Physicians Section.

The AMA just adopted a new policy supporting coverage of fertility preservation for cancer patients. The guidelines from the National Comprehensive Cancer Network and the American Society of Clinical Oncology are both definitive – infertility as a side effect of treatment must be discussed, and fertility preservation should be offered to anyone whose fertility may be compromised by the treatment being offered. Nonetheless, without routine insurance coverage, these guidelines can be an impracticable recommendation for many.

Last July, the Michigan delegation to the AMA presented Resolution 114, asking the AMA to support payment for and lobby for appropriate federal legislation requiring coverage for fertility preservation when cancer treatments may cause infertility. After hearing impassioned testimony from the Michigan delegation and multiple other delegations including medical groups at the intersection on cancer and fertility, the resolution was accepted by the AMA. Dr. Wah will give his perspective on the recent approval of Resolution 114 at the evening reception on Monday, September 9th. You can read more about Resolution 114 HERE.

Registration is still open for the 2013 Oncofertility Conference so please stop by our conference website and register today, and participate in one of the most anticipated reproductive health events of the year!

Tomorrow’s VGR: Psychological Aspects of Fertility Preservation

lawson.cfmTomorrow, August 8th, we are excited to be hosting Angela Lawson, PhD, Assistant Professor of Obstetrics & Gynecology and Psychiatry & Behavioral Sciences at Northwestern University’s Feinberg School of Medicine, for our Virtual Grand Rounds (VGR) at 10 AM CDT, entitled, “Psychological Aspects of Fertility Preservation.” The decision to participate in fertility preservation treatment after a cancer diagnosis is psychologically complex. Dr. Lawson will discuss the psychosocial issues related to adult female fertility preservation including, cost, rapid decision-making, ethical dilemmas, and posthumous reproduction. Click HERE to watch Dr. Lawson present her Virtual Grand Rounds, tomorrow at 10 AM CDT.

Our LIVE Virtual Grand Rounds provide researchers, clinicians, and others the opportunity to hear emerging research findings in cancer and fertility from anywhere across the globe and participate through a live video chat. Virtual and in-person attendees to the rounds can receive free continuing medical education (CME) credits by following the instructions HERE.  Participants can also receive free CME’s by watching a recorded version of the Virtual Grand Rounds which can be found on our website HERE. To read more about receiving education credits from the Oncofertility Consortium, read about the Oncofertility Online program. In addition, we would love to hear your feedback or any suggestions you may have on topics relevant to cancer and fertility for future Virtual Grand Rounds. Visit our Virtual Grand Rounds webpage to submit your ideas.

After Cancer: Surrogacy As a Fertility Option

By Jen Rachman

At age 26, I was living my life, self-sufficient, secure and independent. I took care of myself physically and emotionally. Life was nearly perfect, until the routine trip to the gynecologist that wound up saving my life.

When you hear the words, “you have cancer,” there is truly no way to be prepared to absorb all that comes with it. My now unstable life became filled with terms like prognosis, oncologist, surgery, treatment and chemo.  Suddenly, my secure sense of self became unraveled and presented me with a new identity – cancer patient.

My oncologists’ main goal was to rid me of cancer as quickly as possible. The recommended course of action when diagnosed with ovarian cancer is to have a complete hysterectomy.  I was only 26 therefore the idea of parenthood wasn’t even on my radar yet.  But suddenly the idea of losing my ability to bear children was becoming a harsh reality.  Not willing to relinquish the option of one day having children, I stressed to my doctors how important it was for them to make every attempt at preserving my fertility. Over the course of 7-months, I endured three surgeries, and six rounds of chemotherapy.  Cancer took my hair, put my body in menopause, left me feeling twice my age, and made me infertile.

As time passed further from my date of diagnosis and it became less scary to invest in the idea of leading a longer, healthy life, my thoughts about future began to change.  My then boyfriend and I were married in 2005, and after several years we became comfortable exploring the idea of having a family.  I had come to accept the loss of my fertility and began exploring the options.  I reached out to my oncologist and other survivors I saw as support about surrogacy and adoption.  It quickly became apparent that there was a lack of information about surrogacy.

We met with an organization called Circle Surrogacy, and immediately felt comfortable trusting them with guiding us through this process.  The entire experience felt “right,” as I believe this is the way we were intended to become a family.  Our surrogate is truly an amazing woman who we felt connected to from the start.  The day our boy was born was truly the best day of my life.  It was as if all the struggle and loss caused by cancer had been undone.  Or perhaps more so, solidified the reason for the journey. Through my son’s birth, I realized my experience with cancer and surrogacy brought me a greater sense of purpose. Utilizing my 12-years experience as a social worker, I now coordinate surrogacy outreach to the cancer community.

For more information about your fertility options, please visit the Oncofertility Consortium patient webpage HERE. To learn more about Circle Surrogacy, please click HERE.

2013 Oncofertility Conference: CALL FOR ABSTRACTS!

GlobeThe 7th annual Oncofertility Conference: Cancer and Fertility Around the Globe, is September 9 & 10, 2013, in Chicago, IL, at Prentice Women’s Hospital. The Oncofertility Consortium is seeking abstract submissions for the poster session on Monday the 9th, for work related to the field of cancer and fertility. Each year we have numerous submissions that we must choose from to present to the distinguished oncofertility network of researchers, healthcare providers, patients, and advocates. If you have some fascinating research that you’d like to share, if you are an organization that works directly or indirectly with oncofertility, or if you are doing anything that could benefit the cancer and fertility community, please send in your poster! The deadline is August 1, 2013, so hurry and get them in. Please visit our conference webpage to register for the conference, view the agenda, and submit your abstracts. We look forward to seeing you in September!

Breast Cancer Genes Verdict a Triumph for Women

Below is a guest post by Megan Castle, Program Coordinator for the Women’s Health Research Institute at Northwestern University

By Megan Castle

Geneticists, researchers, and patients joined in celebration over last [month’s] unanimous Supreme Court ruling involving the BRCA1 and BRCA2 genes, colloquially referred to as the “breast cancer genes.”  The Supreme Court ruled that Myriad Genetics could not patent the BRCA1 and BRCA2 sequence of genes, because patents cannot be placed on that which is created organically in nature.  This decision opens the door for researchers outside of Myriad Genetics to study these genes, providing more opportunities to discover early signs of breast cancer susceptibility.  Karuna Jaggar, Breast Cancer Action’s Executive Director reported that this ruling was, “a tremendous victory for women with a known or suspected inherited risk of breast cancer. Today, the Court righted a wrong and has put patients’ health before corporate profits.”

Read more…

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