Fertility Preservation Options, Procedures and Protocols

Fertility preservation services are expanding as advances in cancer treatment are made, allowing people to live longer and fuller lives. As a result, quality-of-life issues including fertility preservation, are a concern for more and more cancer patients within their reproductive years.  In a new article in Reproductive Biomedicine Online by oncofertility researchers Nicole Noyes, MD, Jaime M. Knopman, MD, Katherine Meizer, MD, M. Elizabeth Fino, MD, Brooke Friedman, MD and Lynn M. Westphal, MD, entitled, “Oocyte Cryopreservation as a Fertility Preservation Measure for Cancer Patients,” the authors discuss the various fertility preservation procedures, options, and stimulation protocols available to female cancer patients.

One particular cancer, cervical cancer, is commonly diagnosed during the reproductive years. Historically, the treatment for cervical cancer was a radical hysterectomy, meaning the surgical removal of the uterus, ovaries, oviducts, cervix and related lymph nodes making it impossible for a female to conceive or carry a child.  The radical hysterectomy is often followed by pelvic radiation and chemotherapy depending on what stage the disease is in at diagnosis. As a result of the average age and reproductive potential of women diagnosed with cervical cancer, an alternative treatment for early stage cervical cancer was implemented: the radical trachelectomy.

A radical trachelectomy is the surgical removal of the uterine cervix. As the uterus is preserved, this type of surgery is a fertility preserving surgical alternative and is applicable in selected younger women with early cervical cancer.  According to the authors, “it is estimated that up to half the patients diagnosed in their child-bearing years are eligible for this procedure,” and data suggests that survival is similar to that of a radical hysterectomy. As you may remember from a previous blog, Michelle Whitlock opted for this procedure when she was first diagnosed with cervical cancer in an attempt to preserve her fertility.

Undergoing a radical trachelectomy does not ensure that conception and birth can be achieved. The authors discuss complications that can arise from radical trachelectomy such as cervical-factor infertility, premature delivery, and late-term miscarriage. They also suggest that patients who pursue IVF, opt for a single embryo transfer to lessen their chance of twins and/or miscarriage. To learn more about this procedure as well as other fertility sparing procedures, options, and protocols for women, please click here to read, “Oocyte Cryopreservation as a fertility Preservation Measure for Cancer Patients.”

2012 Oncofertility Conference Launch!!

The Oncofertility Consortium is pleased to announce the launch of the 2012 Oncofertility Conference webpage!  For anyone who doesn’t know yet, the 6th annual Oncofertility Conference  (#oncofert12 for you Twitter folks!) is being held in Chicago this fall, September 26th-28th.  This year will prove to be one of our most exciting and dynamic conferences yet.  If you’ve been waiting to register, peruse our presenter line-up or submit an abstract, now’s your chance.  This year we are also offering some very exciting preconference courses for researchers and clinicians on starting your own fertility preservation program and in vitro follicle growth.

Not forgetting the advocates and all that they do for cancer and fertility, we will be hosting a cocktail hour for the many supporters we’ve joined forces with along the way, including the infamous AYA group, Stupid Cancer.   You know that if Stupid Cancer’s there, you’re bound to have a great time AND be inspired!

Some highlights of this year’s conference include:

We look forward to seeing you in September!

 

The Role of Radiation Oncologists in Fertility Preservation Consultations & Referrals

As we’ve discussed in previous blogs, certain health care providers have a unique role in communicating fertility preservation information to newly diagnosed cancer patients. For example, often a gynecologist is the primary health care provider for many young women, therefore, based on “regular and consistent” interactions with patients, they play a pivotal role in discussing fertility preservation options should the circumstances arise. In a new article by Oncofertility Consortium researchers, Clement K. Gwede PhD, MPH, RN, Susan T. Vadaparampil PhD, MPH, Sarah Hoffe MD and Gwendolyn P. Quinn PhD, entitled, “The role of radiation oncologists and discussion of fertility preservation in young cancer patients,” published in the journal, Practical Radiation Oncology, the authors examined potential differences in practice behaviors, specifically referral and discussion of fertility preservation, among oncologists (ie, surgical oncologists, medical oncologists, and radiation oncologists).

The authors hypothesized that radiation and medical oncologists would be the most likely likely to initiate discussions about fertility preservation and subsequently refer patients to a reproductive specialist. They argued that “due to the inherent scope of radiation and chemotherapy treatment practices that include both verbal and written enumeration of potential short- and long-term treatment toxicities that can arise from the intended course of therapy.” In addition to that, they argued that because radiation treatment takes place over several weeks, patients have daily interactions with staff and weekly treatment exams with the radiation oncologist and nurse putting them in a unique role to discuss fertility preservation with their patients.

The results of their study are very interesting – they found that 82% of radiation oncologists say that they “always/often” discussed the impact cancer treatment may have on fertility compared to only 51% of surgical oncologists, however they found no substantial difference in referral rates with only 24-31% of subspecialty oncologists “rarely/never” referring patients to a reproductive specialist. Their findings suggest that there is still an opportunity to ensure that subspecialty oncologists are provided with appropriate fertility preservation information and resources so that patients receive comprehensive cancer care, including fertility preservation consultations and referrals. This in turn may improve the quality of life of cancer survivors within their reproductive years. To read, “The role of radiation oncologists and discussion of fertility preservation in young cancer patients,” please click here.

National Minority Cancer Awareness Week: April 15th-21st

Fifteen years ago, the U.S. House of Representatives designated the third week in April as National Minority Cancer Awareness Week in an effort to draw attention to the disparities in cancer incident and death rates, stating  “While cancer affects men and women of every age, race, ethnic background, and economic class, the disease has a disproportionately severe impact on minorities and the economically disadvantaged.” Next week, April 15th-21st, is this year’s National Minority Cancer Awareness Week and the Oncofertility Consortium plans to continue to raise awareness about this divisive health discrepancy.

National Minority Cancer Awareness Week promotes increased awareness of prevention and treatment among segments of the population that are at greater risk of developing cancer. The week’s emphasis gives us an opportunity to focus on high-risk populations and to develop innovative approaches to battling cancer incidence unique to these communities.
As reported by the Centers for Disease Control and Prevention (CDC), cancer death rates for women are highest among African American women and new research suggests they are less likely to receive fertility preservation information after cancer diagnosis than Caucasian women. Although cancer deaths have declined for both Caucasians and African Americans living in the US, African Americans continue to suffer the greatest burden for each of the most common types of cancer. For all cancers combined, the death rate is 25 percent higher for African Americans than for Caucasians.

To better understand the disparities among the overall incident and death rates among racial/ethnic groups, please take a look at the tables below provided by the National Cancer Institute (NCI):

Table 1. Female Breast Cancer Incidence and Death Rates

Breast
Racial/Ethnic Group Incidence Death
All 127.8 25.5
African American/Black 118.3 33.8
Asian/Pacific Islander   89.0 12.6
Hispanic/Latino   89.3 16.1
American Indian/Alaska Native   69.8 16.1
White 132.5 25.0

Table 2. Cervical Cancer Incidence and Death Rates

Cervix
Racial/Ethnic Group Incidence Death
All   8.7 2.6
African American/Black 11.4 4.9
Asian/Pacific Islander   8.0 2.4
Hispanic/Latino 13.8 3.3
American Indian/Alaska Native   6.6 4.0
White   8.5 2.3

Although much progress has been made in addressing disparities in cancer treatment and support, there is still much to be done!  Please use National Minority Cancer Awareness Week as an opportunity to continue to push for progress among minority communities in the fight against cancer.

Virtual Grand Rounds Tomorrow: Preserving Sexual Function After Cancer

Quality-of-life issues are important for the many young cancer survivors who will spend decades in post-treatment survivorship. Of the many considerations for survivors, most of the time the Oncofertility Consortium focuses on the reproductive future of young people. However, related issues of sexuality after cancer can have equally significant impacts on later quality of life. Stacy Lindau, MD, MAPP will be sharing her insights on sexual health for survivors at the next Oncofertility Virtual Grand Rounds, tomorrow, April 11th, at 10 AM central time.

Dr. Lindau is an Associate Professor at the Pritzker School of Medicine in the Departments of Obstetrics and Gynecology, Medicine-Geriatrics, and University of Chicago Comprehensive Cancer Center. She is also the director of the University of Chicago’s Program in Integrative Sexual Medicine (PRISM), which uses a multi-disciplinary and multi-institutional approach to solving the sexual health problems of cancer patients. At tomorrow’s rounds, Dr. Lindau will present a “Call to Action to Preserve Sexual Function in Women and Girls with Cancer.”

To join the Oncofertility Virtual Grand Rounds, login to participate beginning at 9:50AM Central Time by visiting http://nwuniversity.na3.acrobat.com/oncofertility. Login as a guest (you will not be given a login), When asked for your name, please try to include your institution (for example: YourName@Northwestern) so we can identify you if you ask a question! For technical assistance, please contact: Zoran Ilic at z-ilic@northwestern.edu

NOTE: test the computer you plan to use the day of the conference for compatibility by visiting:http://nwuniversity.na3.acrobat.com/common/help/en/support/meeting_test.htm

 

Oncofertility joins the AAMC Steering Committee on Women in Medicine and Science

Congratulations are in order for Kate Waimey Timmerman, PhD, who was just named by the American Association of Medical Colleges (AAMC) to the Women in Medicine and Science Steering Committee (GWIMS).  This appointment is an important step for Dr. Timmerman as well as the Oncofertility Consortium as it provides her with the opportunity to advocate for sex and gender equity in health and medicine nationally.

In 2009, the AAMC’s Board of Directors approved the creation of the GWIMS. This committee serves as a national forum for the advancement of women’s success in medicine and science by addressing gender equity, career advancement, awards and recognition, and recruitment and retention. The committee does this through advocacy, collaboration, fact-finding, and the development of initiatives, programs, and networking opportunities. GWIMS also supports women faculty in their development and implementation of institutional policies and professional development activities.

The GWIMS steering committee meets twice a year and provides additional networking opportunities at the AAMC Annual Meeting and the Early and Mid-Career Women Faculty Professional Development Seminars. According to Elizabeth Coakley, Director of GWIMS, “In order to address the growing number of gender-related issues in academic medicine, academic medical centers need visionary representatives who understand the complex responsibilities for women leaders.”

Dr. Timmerman is thrilled with her new appointment adding this new post to her repository of work promoting women in medicine and science. She states, “I am a great believer in collaborative approaches to problem solving and enjoy building relationships with like-minded individuals and groups for similar causes such as women’s education in science and medicine.” Congratulations Dr. Timmerman, we are very excited to see where this road takes you!

National Young Adult Cancer Awareness Week

This week is the 10th Annual National Young Adult Cancer Awareness Week, beginning April 2nd and ending on April 8th. In April 2003, National Young Adult Cancer Awareness Week was launched, and organizations and clinical institutions throughout North America began partnering to raise awareness about the unique needs of this age group. The young adult cancer population is defined as anyone who has been diagnosed with cancer between the ages of 15 to 39, and according to the National Cancer Institute (NCI), more than 70,000 young adults are diagnosed with cancer each year.

Young adults with cancer face unique concerns such as fertility, body image, cognitive function, long-term effects, education, insurance and employment. They also deal with distinct issues based on their age group, still reaching for their goals and dreams, which many older cancer patients have already achieved. For many young cancer patients, they envision themselves with a biological family at some point in their lives so fertility is a top concern for the young adult population.

In 2003, when National Young Adult Cancer Awareness Week was founded, there were few groups or organizations advocating for young adults with cancer. Today though, there is a large movement on behalf of this age group providing a number of services, programs, and networking opportunities including the Oncofertility Consortium, Stupid Cancer, and Imerman Angels among so many others.  There is something for everyone!

For more information on community resources for young adults with cancer, please visit the Patients page of our website. You will find support groups and organizations that cater to the specific needs of young adults diagnosed with cancer. In the meantime, help us bring awareness to the young adult cancer community by spreading the word about National Young Adult Cancer Awareness Week!

Pediatric and Young Adult Cancer Patients and Fertility Preservation

At the Oncofertility Consortium, we stress the importance of collaboration among clinicians, basic scientists, and the humanities in an effort to ensure that cancer patients have fertility options after treatment. This is no small feat, but the emerging field of oncofertility is constantly evolving as new fertility preservation techniques are developed, existing ones are improved and the impact of gonadotoxic cancer treatment is examined. In a new article written by oncofertility researchers, Katherine E. Dillon and Clarisa R. Gracia, and edited by Jacqueline Jeruss, in the journal, Current Treatments in Oncology, entitled, “Pediatric and Young Adult Patients and Oncofertility,” the authors explore the various fertility preservation options available to pediatric and young adult patients and argue that a team approach is needed between oncologists and reproductive endocrinologists in order to provide the best outcomes for young patients.

Among the fertility preservation techniques currently available, the authors discuss options available for both males and females including lesser known options for females such as oophoropexy (relocating the ovaries out of the radiation field to protect them from exposure during treatment), and hormone replacement therapy for pre-pubertal cancer patients. Options available for males are sperm banking and testicular tissue banking for pre-pubescent males. Testicular tissue banking is still experimental and requires further scientific development.

Increasing numbers of pediatric and young adult cancer patients are surviving well into their reproductive years, therefore the authors state that clinicians need to be informed about the impact of cancer therapies on both males and females, as well as the available fertility preservation techniques for this demographic. They also maintain that it is imperative for clinicians to understand the most recent advances in oncofertility to better understand the future direction of the field and potential fertility preservation techniques that will one day be practiced in a clinical setting. To read, “Pediatric and Young Adult Patients and Oncofertility,” please click here.

Oncofertility: A Global Perspective

Christi Sodano from the Medill School of Journalism brings us the following insight on the global needs in fertility preservation for young patients. Read her first blog post.

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By Christi Sodano-

No longer just an old person’s disease, cancer among young people is increasingly prevalent. And while the growing field of oncofertility is gaining steam here in the U.S., more education and coordinated efforts are required to provide global awareness of the issues that young cancer patients face.

One of the main problems patients around the world often encounter is the lack of education or awareness among oncologists about new treatments and possibilities in the world of oncofertility.

Doctors are often concerned that delaying cancer treatment for fertility preservation procedures will harm the patient, said Dr. Melissa Hudson, director of the Cancer Survivorship division at St. Jude Children’s research hospital.

“Our perception as oncologists is that almost all options are still investigational. Because of this, fertility preservation is not really a priority. Those feelings can be easily transmitted to the patient,” she said.

However, she notes that especially in the cases of children with less aggressive cancers, a brief delay could be okay. It may only take a few days to harvest ovarian tissue that could enable an otherwise sterile young girl to have children later in life, something that is not widely accepted.

While physician education is ideal, patient awareness could ultimately solve this problem.

Many times patients go to their doctors after reading something in the media regarding oncofertility and that is how they learn about treatment options, said Johan Smitz, a fertility specialist and laboratory head at UZ Brussels.

“It all starts by educating the profession about the huge growth reproductive medicine has had over the last 30 years,” Smitz said.

Doctors now routinely take ovarian tissue samples and oocytes and freeze them as a method of preserving fertility. “I think it is now 17 live-births resulting from tissue culture,” said Prof. Teresa Woodruff, Ph.D., of Northwestern University’s Feinberg School of Medicine and  founder of the Oncofertility Consortium.

But awareness alone will not be enough to overcome the international barriers facing oncofertility. Coordinating national efforts is key in addressing this problem, Smitz said.

“There are approximately 1.4 million people in the world that will have a fertility threatening treatment. And globally, everyone needs to be aware that fertility preservation is a problem,” Woodruff said.

In some European countries, funding is largely dependent on publishing papers that impact the field of research.

“[In Belgium], the government provides funding for four years and they expect to see a lot of output from that, but the problem is, putting gonadal tissue in culture requires long-term research because it can take months to grow one mature, human oocyte,” Smitz said.

In an effort to address this issue and better coordinate research efforts, the European Society for Human Reproductive Embryology partnered with America’s Oncofertility Consortium to share information across borders.

Despite these efforts, one thing is clear, more research and awareness are required before fertility preservation becomes a mainstream global effort for cancer patients.

 

 

New Study: Fertility Preservation Disparities in Women

A retrospective study is being published today that gives us a better idea of the barriers to fertility preservation among women with cancer. In the study, about 1,000 women who were diagnosed with cancer between 1993 and 2007, were asked about their counseling on fertility preservation prior to potentially-sterilizing treatments such as chemotherapy, pelvic radiation, pelvic surgery, or bone marrow transplant. Though more than 60% of survivors remember being counseled on fertility, only 4% actually pursued fertility preservation. This study also identified what factors made it more or less likely to be counseled and proceed with fertility preservation.

The study by Letourneau, Smith, Ebbel, Craig, Katz, Cedars, and Rosen asked women with common non-gynecologic cancers that are often treated with chemotherapy that may damage fertility, to participate in a study. In a recent interview, Teresa K. Woodruff  stated that “the study takes advantage of the  California Cancer Registry, which is a good tool for retrospective studies.” The authors found the women who chose to participate in the study averaged about 31 years old at the time of cancer diagnosis and 54% desired to have children after treatment.

In the article, “Racial, Socioeconomic, and Demographic Disparities in Access to Fertility Preservation in Young Women Diagnosed With Cancer,” though more than 50% of survivors reported to receive counseling about fertility by their oncology team, age, a desire for future children, and education level were more likely to receive counseling. Women with a college degree or greater were 20% more likely to receive counseling than women without.

Of all women, only 4% actually underwent fertility preservation. Age, a desire for children, lack of children, and education were significantly associated with these treatments. Additional non-significant trends indicate that, older women (over 35), those with children, and Latina women were less likely to pursue preservation. In the study, none of the 31 African American women and 29 women who identified with a sexual orientation other than heterosexual underwent fertility preservation.

While this study in Cancer highlights that disparities between fertility counseling and preservation services are still prevalent, there is some good news. First of all, though 60% of women in the survey reported to receiving fertility counseling, these increased approximately 1% a year between 1993 and 2007. Similarly, fertility preservation procedures were not reported at all in 1993, increased to 2% in 2000, and since then have been rising slightly more than 1% per year.

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Are you a cancer survivor? Help oncofertility researchers study and prevent treatment-induced fertility loss by participating in fertility research for cancer survivors!

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