By Yogesh Makanji

In an Australian first, Monash IVF specialists reported achieving pregnancy in a 43-year-old woman after transplanting her cryopreserved ovarian tissue. Professor Gab Kovacs, Director of Monash IVF, Melbourne Australia, reported that his team had restored fertility in a woman by transplanting her cryopreserved ovarian tissue, following which she resumed natural ovulation and was six weeks pregnant. In 2005, this woman had ovarian tissue cryopreserved prior to commencing breast cancer treatment. If successful pregnancy ensues then in another Australian first, this would be the first Australian baby born from transplanted ovarian tissue and 20^th in the world. In light of their success, Professor Kovacs went on further to recommend ovarian tissue cryopreservation as a reliable, cheaper and easier method of preserving fertility of cancer patients; compared to cryopreserving eggs or embryos.

Adding to the commentary, Dr. Lyndon Hale, Medical director of Melbourne IVF Clinic, Australia reported that they had successfully transplanted ovarian tissue in patients and only one had become pregnant. However, she had subsequently miscarried. Dr. Hale also sees the benefits of this technique for preserving fertility of cancer patients.

Another trend emerging from this article is the use of cryopreserved ovarian tissue as a way of preserving a women’s fertility indefinitely.  In addition, it has been suggested that ovarian tissue transplant in peri-menopausal women may delay or offset symptoms associated with menopause; hot flashes, osteoporosis, weight gain, etc. Neither Professor Kovacs nor Dr. Hale is advocating the use of ovarian tissue transplant for this purpose. Hormone replacement therapies are available to alleviate some of these menopausal symptoms.

Ovarian tissue cryopreservation is providing many young cancer patients the opportunity to preserve their fertility. Chemo and radiotherapy may adversely affect a women’s future fertility. Thereby, cryopreservation of ovarian tissue prior to cancer treatment protects a women’s future fertility.

Source: The Age http://www.theage.com.au/national/health/science-beats-fertility-clock-20121128-2aev2.html

Finding out your pregnant can be one of the happiest times in your life. Couple that with a cancer diagnosis and suddenly you’re not only concerned about your health, but that of the new life you are busy growing. Cancer during pregnancy is rare, occurring in approximately one out of every 1,000 pregnancies, and breast cancer is the most common cancer diagnosed during pregnancy. Currently, little research is available to guide women and doctors during this uncertain time.

When making treatment decisions for cancer during pregnancy, the doctor considers the best treatment options for the mother and the possible risks to the baby. The type of treatment given depends on many factors including, gestational age of the baby; the type, location, size, and stage of the cancer; and the decisions of the expectant mother and family. Some cancer treatments can harm the fetus, especially during the first trimester; therefore, treatment may be delayed until the second or third trimesters. When cancer is diagnosed later in pregnancy, doctors may wait to start treatment until after the baby is born, or they may consider inducing labor early.

Unfortunately, the current medical literature cannot answer all the relevant questions for a woman facing a cancer diagnosis during pregnancy. Few oncologists or obstetricians treat more than 2 or 3 patients in this situation in an entire career. The only way to gain the necessary knowledge about cancer found and treated during pregnancy is to gather together experience from various hospitals into one single database. To the benefit of oncofertility, Dr. Elyce Cardonick, a Maternal Fetal Medicine Physician at Cooper University Health Care in New Jersey, is doing just that.

Dr. Cardonick has created a health registry, which collects information about the diagnosis, and treatment of cancer in pregnant women. According to Dr. Cardonick, the information collected is strictly confidential and will help study the effects of a newly diagnosed cancer and its treatment on a concurrent pregnancy. Additionally, the interaction of a pregnancy on the natural history of certain types of cancer will also be studied. Some women have even received chemotherapy during pregnancy and delivered healthy infants. Dr. Cardonick is also interested in including pregnant women with a history of cancer in a separate database. In both studies, the health of the women and their children are followed yearly in cooperation with the patient’s oncologist, pediatrician and obstetrician.

For more information about the pregnancy and cancer registry or to become a participant, please call (877) 635-4499 or visit www.cancerandpregnancy.com. To learn more about the role of OB/GYN in comprehensive cancer care, please read this previous blog.

The oncofertility community aims to educate both oncology and reproductive specialists throughout the United States and across the globe. Over the past five years, the Oncofertility Consortium has done this through an annual conference and monthly Virtual Grand Rounds. This year, we’ve gone one step further in providing clinical education by offering continuing medical education credits (CMEs) to health care providers, including physicians, nurses, and physicians assistants.

This program, called Oncofertility Online, allows health care providers to watch virtual presentations from the 2012 Oncofertility Conference and receive CME credits for their participation. In addition, providers can now watch live or recorded presentations from selected Virtual Grand Rounds (October 2012 – October 2013).

If you are interested in receiving CMEs by watching these recordings, just find a presentation and follow the instructions, which include taking a brief pre-test, watching the recording, and taking the post-test!

Also, you can join the next live Virtual Grand Rounds on Thursday, December 13th, 2012 at 10 AM Central Time on the “Reproductive Impact of Cancer Treatments and Fertility Preservation Options for Cancer Patients” which will be led by Jennifer Hirshfeld-Cytron, MD, MSCI, Assistant Professor, Obstetrics & Gynecology, University of Illinois Medical Center and Mary Ellen Pavone, MD, Assistant Professor, Obstetrics & Gynecology, Northwestern University. View the current list of the 2013 Virtual Grand Rounds here.

Oncofertility is an interdisciplinary field at the intersection of oncology and reproductive science. While those two fields make up the breadth of this discipline, it only touches the surface of what future clinicians need in their academic repertoire to successfully navigate this field.  In “Preparing an Interdisciplinary Workforce in Oncofertility: A Suggested Educational and Research Training Program,” in Oncofertility Medical Practice: Clinical Issues and Implementation, author Christos Coutifaris, MD, PhD, argues that the education and training of oncofertility professionals should involve, “oncology, pediatrics, reproductive science and medicine, biomechanics, material science, mathematics, social science, bioethics, religion, policy research, reproductive health law, and cognitive and learning science.”

Going forward, the National Institute of Health (NIH) has an ambitious agenda requiring multifaceted scientists and clinicians properly trained in both research and medicine. Ideally, physicians would be trained not only clinically, but they would also be prepared for investigative careers. According to Dr. Coutifaris, “the ultimate goal is to prepare reproductive endocrinologists, pediatric and adult oncologists, and surgeons, for investigative careers that focus on the reproductive, endocrine, and fertility needs of cancer patients and survivors.” By doing so, oncofertility specialists would be at the forefront of translational medicine, further benefiting the reproductive outcomes of cancer patients.

Dr. Coutifaris presents a well-laid training program for future oncofertility specialists. This includes establishing an executive steering committee responsible for the overall direction of the program, an advisory board to aid and shape the content of the program, an expert and diverse group of faculty members to mentor trainees, and research training, specifically focusing on the human oocyte. There should also be a comprehensive program evaluation in place to monitor the success of the program.

Having a dedicated oncofertility program in place to ensure that fertility options for young cancer patients is factored into their cancer care, is imperative.  Training and educating the next generation of oncofertility specialists will lay the foundation for improved cancer care and reproductive outcomes. Read, “Preparing an Interdisciplinary Workforce in Oncofertility: A Suggested Educational and Research Training Program,” to learn more about educating the next generation of oncofertility specialists. Participate in our new series of CME-accredited Virtual Grand Rounds to increase communication and education among healthcare providers.

The emerging field of oncofertility gives rise to many ethical questions, particularly those focusing on who is offered fertility preservation, how it’s paid for, and what’s done with the reproductive material (eggs, embryos, sperm) after retrieval. These are the most common ethical issues pertaining to fertility preservation and unfortunately, they are no universal answers as each case presents differently and requires a unique solution.  In a new article entitled, “Addressing the Most Frequently Asked Questions of a Bioethicist in an Oncofertility Setting,” in Oncofertility Medical Practice: Clinical Issues and Implementation, author Lisa Campo-Engelstein, PhD, examines those questions as a bioethicist within the Oncofertility Consortium.

Who Should Be Offered Fertility Preservation: This question has many layers to it. There are age-based issues concerning minors, and their role in making these types of long-term multifaceted decisions.   Along with age concerns comes prognosis concerns. Should we be offering fertility preservation services to cancer patients with a poor prognosis? Studies suggest that talking with patients about fertility preservation gives them hope for a life beyond cancer, and may be a motivating factor in their recovery. Finally, marital status or lack thereof, can be a concern for some insurance providers who are unwilling to provide coverage for individuals who are not married, and to complicate matters even further, they may require that the reproductive material being used come from the couple as well.

Paying for Fertility Preservation:  Insurance companies often do no pay for fertility preservation even though fertility loss is a direct result of cancer treatment. According to Dr. Campo-Engelstein, “If health professionals cause harm – a violation of Hippocratic Oath – then the medical profession as a whole must assume responsibility for alleviating this harm.” This applies to breast reconstructive surgery, so why not fertility preservation as well?

Disputes Over Reproductive Material: Reproductive material, by law, is deemed “property” and it is the property of the people who make up its genetic material. In the case of minors, since the reproductive material is technically theirs, parents should not be able to make decisions about using, destroying or donating that material before the child turns 18, and can legally assume sole ownership over their “property.” Furthermore, should parents have the legal option of using their child’s posthumous reproductive material or should it immediately be donated to science or destroyed?

To learn more about ethical issues oncofertility providers face and potential ways to mitigate, prevent or resolve them, please read, “Addressing the Most Frequently Asked Questions of a Bioethicist in an Oncofertility Setting.”

The month of November kicks off the sixth annual Movember fundraising campaign to raise vital awareness and funds for men’s health issues, specifically prostate and testicular cancer initiatives.  Every November, men are encouraged to grow out their moustaches for the entire month in support of men’s health. Last year, Movember raised over half a million dollars in Chicago alone and almost $300 million has been raised worldwide since 2003.

This year’s theme of Movember & Sons, reminds us how knowledge is shared and wisdom gets passed down from one generation to the next. This year Movember & Sons focuses on family and generational health — essentially, the knowledge transfer that happens from dad to son — and then, later in life, from son back to dad.

The Movember campaign goals are as follows:

Survivorship: To fund survivorship initiatives that provide information and support for men and their families affected by prostate and other male cancers that helps them make informed decisions and improves their quality of life, include information about fertility preservation.

Awareness and Education: To significantly increase the understanding of the health risk that men face and encourage men to act on that knowledge.

Prostate Cancer Research: To fund catalytic research and clinical trials infrastructure that leads to significantly improved diagnostic and prognostic tests and treatments to reduce the burden of prostate cancer.

Influencing Change in Men’s Health: To fund research that helps to inform health policy and knowledge translation that accelerates improved health outcomes for men.

The funds raised are directed to programs run directly by Movember and their men’s health partners, the Prostate Cancer Foundation and LIVESTRONG Foundation. Together, the three channels work together to ensure that Movember funds are supporting a broad range of innovative, world-class programs. For more information on these programs and other Movember initiatives, please visit the following websites: Prostate Cancer Foundation, LIVESTRONG Foundation, Awareness & Education, and Global Action Plan.

So start growing out those moustaches men, and if you’d like to learn more about your reproductive health after a cancer diagnosis, please visit out SaveMyFertility.org or visit our Virtual Patient Navigator.

Talking with teenagers about fertility can be awkward and uncomfortable. Talking with teenagers and their families about a cancer diagnosis is devastating. How do we do both at the same time and ensure that the importance of fertility preservation is understood in light of the traumatic timing? Studies among adult cancer survivors show that fertility is their most prevalent concern, thus we need to develop a method for relaying this information to young cancer patients and their families in a timely and sensitive manner. In the article, “The Birds and the Bees and the Bank: Talking with Families Amidst a Cancer Diagnosis,” by Gwendolyn P. Quinn, Caprice A. Knapp, and Devin Murphy, in Oncofertility Medical Practice: Clinical Issues and Implementation, the authors propose using a new method for initiating these discussions.

Patients and their families often look to health care providers to guide them in their decision-making process. Receiving a cancer diagnosis is very traumatic and can leave both the patient and their parents in a highly emotional state. They may not remember all that they were told in that initial discussion, but unfortunately decisions need to be made in that moment that will have an impact on their life many years later. Depending on the cancer diagnosis and the treatment protocol, loss of fertility may be a consequence., and needs to be addressed.

Studies show that communicating with patients using interactive tools, increases a patients understanding of the information being presented. Additionally, understanding is further increased, specifically when individual decision-making is involved, using a values clarification exercise or tool. According to the authors, “A values clarification tool (VCT) is often used in environments in which a common shared vision or purpose is required, the goal of which may be to develop the common vision, define roles, or develop long-range plans.” A VCT serves as a primer for future decision-making because it does not asks participants to ponder hypothetical situations, but instead aids them in defining the values and beliefs that influence their behavior. The authors maintain, “The open-ended statements of the VCT encourage patient/parent and administrator to begin a dialogue so that the patient/parent may process the idea of having children first, and then consider their feelings about possibly not being able to have children in their future.”

Allowing young patients to take an active role in making decisions about their fertility by evaluating their own beliefs and behaviors, and processing the idea of potential infertility, can actually serve to empower their decision-making process. Studies show that adolescent and teenage cancer survivors have clear expectations about parenthood and having biological children, yet are not always able to fully express these desires. The VCT can be a helpful tool in initiating these types of discussions. Read, “The Birds and the Bees and the Bank: Talking with Families Amidst a Cancer Diagnosis.” Learn more about your fertility options by visiting our Virtual Patient Navigator.

We are happy to be hosting Helen Picton, BSc, PhD, FSB for her Virtual Grand Rounds presentation tomorrow, October 25th, 2012, at 10 AM Central Time, entitled, “From Basic Science to Clinical Application- the Facts and Future of Ovarian Cryopreservation for Fertility Preservation.”  Dr. Picton’s work focuses on characterizing ovarian follicles during growth and maturation, and the developmental competence of in vitro oocytes, and will inform her discussion of the research behind ovarian tissue freezing and how to apply that technique in a clinical setting now, and as we move forward with advancements in the reproductive field.

Receive free CME’s tomorrow by participating in tomorrow’s Virtual Grand Rounds (VGR) with the Oncofertility Consortium. VGR’s are live videoconferences with experts in the fields of reproduction, cancer, and oncofertility. They provide researchers, clinicians, and others the opportunity to hear emerging research findings from anywhere across the globe and participate through a live videochat. This year, the Oncofertility Consortium is also able to offer free CME credits to health care providers through these live virtual events.

At 10 AM, Central Time, click here to watch Dr. Picton present her Virtual Grand Rounds.

This weekend kicks off the 68^th annual meeting of the American Society for Reproductive Medicine (ASRM) in San Diego, CA and runs through October 24^th.  ASRM was founded in 1944 by a small group of fertility experts in Chicago and since then, distinguished members of ASRM have led the development of the field of reproductive medicine.  They were the first physicians to perform many of the standard procedures used by fertility specialists today, including donor insemination and in vitro fertilization, and they have helped form key legislation and fought for reproductive rights when public policy in reproductive matters did not exist.

Today, ASRM members reside in all 50 of the United States and in more than 100 other countries.  ASRM is multidisciplinary, with members including obstetrician/gynecologists, urologists, reproductive endocrinologists, embryologists, mental health professionals, internists, nurses, practice administrators, laboratory technicians, pediatricians, research scientists, and veterinarians. Needless to say, the Society is an authority on reproductive medicine and has been for over half a century, and at this year’s conference, a very important announcement is going to be made: egg freezing is no longer considered an “experimental” fertility preservation technique.

The practice of freezing eggs has long been controversial with many experts arguing there’s too little data on how well it works or how safe it is. Up until now, clinicians mostly recommended it for female cancer patients whose fertility may be at risk as a result of cancer treatment in situations where embryo banking is not an option or as an additional safeguard to embryo banking. The published report upgrading egg freezing from experimental to standard, prepared by the Society for Assisted Reproductive Technology (SART) Practice Committee, reviewed nearly 1,000 published studies about egg freezing and concluded that sufficient studies have been done to warrant considering egg freezing as a clinically available technique due to improved freezing and thawing techniques.

So what does this mean for cancer patients? Removing the “experimental” label may make it easier for cancer patients to receive insurance coverage if they choose egg freezing as their method of fertility preservation. It may also become a more appealing choice if it’s considered a clinically standard technique. Although there are no guarantees in any fertility preservation technique, patients may be less likely to choose experimental procedures over conventional ones.

We will have more information for you next week as this story unfolds and the report is published…

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 3^rd book, Oncofertility Medical Practice: Clinical Issues and Implementation, addressing the clinical aspects of fertility preservation.  The entire book culminates with a 15^th 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.