Preserving Oocyte Reserve

Today we welcome Dr. So-Youn Kim from Dr. Woodruff’s Lab at Northwestern University as our guest blogger.  Dr. Kim will review a recent article published by Dr. John C. Schimenti in Science 2014.

ONE MORE STEP TOWARDS PRESERVING OOCYTE RESERVE

By: So-Youn Kim, PhD

According to a paper published by Dr. John C. Schimenti and colleagues in Science in 2014, Reversal of Female Infertility by Chk2 Ablation Reveals the Oocyte DNA Damage Checkpoint Pathway, mice that have knock out checkpoint kinase 2 (chek2-/- or chk2-/-) are protected against radiation damage to oocytes (1). These Chk2-deficient female mice do not have fertility problems.  Radiation did not eliminate primordial follicles in Chk2-deficient female ovaries, compared with that of wild-type animals, and Chk2-deficient mice gave birth to an average litter size. This gives researchers further hope that oocytes can be protected during chemo- or radiation therapy in cancer patients.

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Depletion of p63-positive primordial follicles by IR is CHK2-dependent. Ovaries were cultured 7 days after irradiation. Scale bars, 100 μm. MVH marks oocytes. (Insets) Ovary cortical regions containing primordial follicles (Schimenti J.C. et al, Science, 2014)

Checkpoint kinase 2 (CHK2) is a protein component of the meiotic DNA damage checkpoint that plays a role in DNA repair. It is a downstream molecule of ataxia telangiectasia mutated (ATM), which is activated to DNA double strand breaks (DSBs), or ataxia telangiectasia and Rad3 related (ATR; FRP1), which is responsive mainly to single-stranded DNA breaks (2,3). CHK2 may transfer the signal to downstream molecules, p63/p53 (/p73), to decide the destiny of cells. Schimenti’s team showed that irradiated Chk2-/- mice did not phosphorylate TAp63, a protein that has known as a guardian in oocyte to protect female germline (4). The team showed that CHK2 signals to both p53 and TAp63 when oocytes get DSBs by showing that irradiated p53-/- TAp63-/- has similar protection of Chk2-/- female. Therefore, if the repair systems by CHK2 fail to fix DNA damage, it will induce the signaling pathway of p53/TAp63, causing the depletion of ovarian follicle reserve.

Women who are treated with chemo- or radiation therapy are faced with the depletion of ovarian reserve, causing premature ovarian failure and destruction of the endocrine system. Chemo- or radiation therapy is especially detrimental to women who have not yet given birth, but hope to have children later in their life.

Many groups have done research to protect oocytes against chemo- and radiation therapy by figuring out the key target molecules and effective inhibitors. There are several candidate inhibitors so far such as GnRH analogues (5), S1P (6), AS101 (7), and Imatinib (8). But there is still controversy as to how to protect oocytes against chemo- and radiation therapy. None of these have yet been tested in mice to kill cancer cells while protecting the ovarian reserve. If CHK2 is a key molecule in the signaling pathway of oocyte death as Schimenti’s team proposed, the use of CHK2 inhibitor could be an ideal way to protect oocytes against apoptotic pathway by radiation and give time to repair DNA damage in oocytes while killing cancer cells.

We cannot determine the healthiness of oocytes undergoing these treatments although the inhibitors could prevent the death of oocytes during chemo- and radiation therapy in cancer patients. Although the radiated oocytes from Chk2-/- mice produced healthy pups, the team would need to pursue much deeper research to study the genomes of the pups to determine if they contain DNA mutations when CHK2 inhibitors are used. While more research needs to be done, this is another step towards fertility preservation in cancer patients.

References:

  1. Bolcun-Filas E, Rinaldi VD, White ME, Schimenti JC. Reversal of female infertility by Chk2 ablation reveals the oocyte DNA damage checkpoint pathway. Science. 2014;343(6170):533-536.
  2. Wang XQ, Redpath JL, Fan ST, Stanbridge EJ. ATR dependent activation of Chk2. Journal of cellular physiology. 2006;208(3):613-619.
  3. Hirao A, Cheung A, Duncan G, Girard PM, Elia AJ, Wakeham A, Okada H, Sarkissian T, Wong JA, Sakai T, De Stanchina E, Bristow RG, Suda T, Lowe SW, Jeggo PA, Elledge SJ, Mak TW. Chk2 is a tumor suppressor that regulates apoptosis in both an ataxia telangiectasia mutated (ATM)-dependent and an ATM-independent manner. Molecular and cellular biology. 2002;22(18):6521-6532.
  4. Suh EK, Yang A, Kettenbach A, Bamberger C, Michaelis AH, Zhu Z, Elvin JA, Bronson RT, Crum CP, McKeon F. p63 protects the female germ line during meiotic arrest. Nature. 2006;444(7119):624-628.
  5. Osborne SE, Detti L. GnRH-analogues for ovarian protection in childhood cancer patients: how adult hypotheses are relevant in prepubertal females. Current drug targets. 2013;14(8):856-863.
  6. Zelinski MB, Murphy MK, Lawson MS, Jurisicova A, Pau KY, Toscano NP, Jacob DS, Fanton JK, Casper RF, Dertinger SD, Tilly JL. In vivo delivery of FTY720 prevents radiation-induced ovarian failure and infertility in adult female nonhuman primates. Fertility and sterility. 2011;95(4):1440-1445 e1441-1447.
  7. Kalich-Philosoph L, Roness H, Carmely A, Fishel-Bartal M, Ligumsky H, Paglin S, Wolf I, Kanety H, Sredni B, Meirow D. Cyclophosphamide triggers follicle activation and “burnout”; AS101 prevents follicle loss and preserves fertility. Science translational medicine. 2013;5(185):185ra162.
  8. Gonfloni S, Di Tella L, Caldarola S, Cannata SM, Klinger FG, Di Bartolomeo C, Mattei M, Candi E, De Felici M, Melino G, Cesareni G. Inhibition of the c-Abl-TAp63 pathway protects mouse oocytes from chemotherapy-induced death. Nature medicine. 2009;15(10):1179-1185.

 

Communication: From Professionals to the Public

Screen Shot 2014-02-18 at 10.23.36 AMWe live in a digital age where more information is available at our fingertips than ever before.  We now have access to information in a matter of seconds that used to take weeks to locate through time intensive literature reviews at the library.  Chapter 12 of Oncofertility Communication: Sharing Information and Building Relationships across Disciplines is devoted to the unique set of challenges presented through these new and varying methods of communication.  In this chapter, Oncofertility Communication Tools for Professionals and the Public, authors Stefani Foster LaBrecque, Harlan Wallach, and Kate E. Waimey identify the many communication platforms utilized in Oncofertility.  Because Oncofertility, by nature, requires reaching multiple disciplines and stakeholders, communication strategies must be geared towards everyone from high level scientists to patients and their families.

Communication tools range from primary and review articles in scientific journals to social media; each end of the spectrum presenting a differing set of hurdles.  For example, academic publications have credibility with funding sources and in scholarly settings but often reach a small group of already engaged stakeholders.  On the other hand, social media reaches a very large audience but credibility is often in question as the information distributed is not subjected to a rigorous review process.  Thankfully, a number of communication tools have been developed to bridge the gap.

Professional websites can be a wonderful resource for clinicians and patients searching for information.  The Oncofertility Consortium website has different sections specifically geared towards researchers, clinicians, and patients and are modified routinely to keep up with technology and the needs of our audience.  Websites can be used to host archived information from previous presentations, publications, and procedures as well as broadcast new information.  A unique aspect of the Oncofertility Consortium website is our interactive National Physicians Cooperative map which identifies collaborative practices with ‘pins’ on the map.  Providers can view the map and see what hospital systems they can refer patients to and patients can access this same information to find the best fit for them.  In conjunction with the Oncofertility Consortium website, patients and providers are encouraged to use the Fertility Preservation Patient Navigator website which is instrumental in connecting patients with fertility preservation providers.

Moving past websites, Chapter 12 discusses the new rolScreen Shot 2014-02-18 at 10.32.48 AMe of virtual meetings in the communication toolbox.  Current mechanisms for virtual meetings are Vidyo videoconferencing which allows for face-to-face audio, visual, and data-sharing and Adobe Connect, where a single presenter broadcasts video and data slides and viewers ask text-based questions that can be answered in real time.  These newer technologies have really helped to bridge the gap between clinicians and the public as well as broadcast clinical scenarios for input from colleagues across the globe.  While these technologies will never replace the benefit of in-person communication, it is a way to foster those relationships when distance and schedules conflict.

The next generation of technology involves the utilization of smartphones.  People are constantly connected to their smartphones and we are identifying ways to reach patients through this ever-present device.  The Oncofertility Consortium led the charge with their iSaveFertility app for the iPhone which provides clinicians the ability to view educational pocket guides about fertility preservation in men, women, and children and email applicable information directly to patients from the app.  A web-version was launched in conjunction in the app to make consistent information available to non-iPhone users and those wanting to view information on their desktop.  The next step is upgrading the app for use on newer iPhone platforms and having a counterpart available for android users.  Again, technology keeps evolving and we need to keep up!

The best way for technology to educate patients and their families is through Public-Facing Web sites.  These sites house short videos of patients, scientists, and health care providers, and include animations which are especially useful for children or individuals with poor literacy.  One example of a public-facing website is MyOncofertility.  MyOncofertility is a patient education website available through the Oncofertility Consortium which provides concise information to patients and their families regarding treatment options and available resources.  The Oncofertility Consortium receives feedback from patients and can edit material based on what is desired by the public.  From these comments, the Consortium is able to locate new avenues to reach the public.  The most applicable one being social media.  To complement the information provided on public-facing websites, the Oncofertility Consortium maintains a social media presence through Facebook, Twitter, YouTube, and the Oncofertility Consortium blog.  With these tools, it is easy to keep a large community informed of upcoming events, existing tools available through the Consortium, and support our wide range of collaborators.

Moving forward the Oncofertility Consortium is dedicated to strengthening the survivor-patient-provider connection through both updated technology mechanisms and in person communication.  This will be done through our established web presence (websites and social media) as well as discussions with our national and global partners to receive input on current experiments and procedures.  Continue reading Oncofertility Communication: Sharing Information and Building Relationships across Disciplines and tour our Oncofertility Consortium resources for more information.

 

What is Shared Decision Making?

Screen Shot 2014-02-11 at 2.24.57 PMOncofertility Communication: Sharing Information and Building Bridges across Disciplines is divided into two parts.  Part I is Communicating with Patients and Their Families and outlined in Chapters 1-10.  Part II, Communicating with Healthcare Professionals, Stakeholders and the Public starts with Chapter 11, An Interprofessional Approach to Shared Decision Making: What it Means and Where Next.  The authors France Légaré and Dawn Stacey delve into the intricacies of an interprofessional healthcare team approach and what it means for patients who wish to be engaged in the decision making process.

An interprofessional approach is a process by which two or more professionals collaborate to provide integrated and cohesive care to address the needs of their patient population.  It has the potential to link multiple professionals (physicians, nurses, social workers, physical therapists, etc.) with patients and families and help eliminate communication and information gaps in the healthcare system.  Oncofertility is a field whose success relies heavily on interprofessional decision making.  Oncologists, reproductive endocrinologists, nurses, and psychologists work together to provide quality care in a timely manner.  While many advances have been made,  clinical decision-making processes still need to be improved to involve patients and their wishes within the framework.  Additionally, more work needs to be done to identify and implement conceptual models underlying interprofessional approaches to shared decision making and those already in place need to be validated in clinical settings.

The Oncofertility Consortium is a prime example of how interprofessional approaches can successfully drive patient care.  Our Fertility Preservation Patient Navigator helps to bridge the gap between clinicians and patients in a way that allows patients to feel empowered and involved in the decision making process!

Perspectives on Fertility

978-1-4614-8234-5 (1)Oncofertility Communication: Sharing Information and Building Relationships across Disciplines devoted an entire chapter to the communication strategies and issues faced by oncology providers.  Chapter 10 is entitled Fertility Communication to Cancer Patients: A Hematologist-Oncologist’s Perspective and is authored by Sara Barnato Giordano.  As cancer treatments have advanced, the percentage of survivors continue to grow.  Today, approximately 80% of adolescents and young adults given a cancer diagnosis will survive and be faced with a new set of challenges as long-term survivors.  Many studies have shown that young women have a number of concerns related to sexual health, infertility and menopausal symptoms and there is significant room for improvement in communication and counseling in this patient group.

The American Society of Clinical Oncology (ASCO) released guidelines in 2006 that suggested that oncologists should address the possibility of infertility with patients treated during their reproductive years and be prepared to discuss possible fertility preservation options.  They followed up these guidelines with a program, Quality Oncology Practice Initiative (QOPI) that established age-based parameters to provide guidance to oncologists when selecting available fertility preservation options to discuss with patients.  Surveys have indicated that oncologists are often wary of referring patients for fertility preservation consultation for fear of delaying treatment too long or assuming that their patients would not be interested in discussing fertility.  The ASCO guidelines were meant to be an impetus for implementing stronger fertility preservation programs but significant barriers still exist.

The author describes categories of barriers: health care system barriers, physician barriers, communication barriers, adolescent and young adult barriers, and parent barriers.  Each present their own set of unique challenges.  Health care system barriers demonstrate that while national guidelines have been disseminated and accepted, hospitals do not have procedures or policies in place that enforce the implementation of guidelines or designate which health care provider (physician, nurse, patient navigator, etc) are responsible for initiating the discussion.  This leads into the next barrier: physician barriers.  Physicians are often reluctant to endorse fertility preservation as they feel discussing infertility and fertility preservation options are neither appropriate nor an immediate clinical priority in light of a cancer diagnosis.  Beyond that, physicians are tasked with providing a large amount of information to patients in a short amount of time after their cancer diagnosis which is where the communication barrier is most evident.  Patients are flooded with information relating to diagnosis, treatment, side effects, and outcomes and the discussion of fertility preservation is often considered a lower priority.  In addition, adolescent and young adult barriers and parent barriers are often intertwined throughout the course of cancer diagnosis and discussion.  Discussion about fertility, such as sperm banking and ovarian stimulation, can be uncomfortable for adolescents or young adults and the process for fertility preservation can seem daunting in the face of a cancer diagnosis.  Parental barriers often relate to lack of knowledge about the emotional development and cognitive process of their child as well as varying religious or cultural values of the family.  Occasionally, the patient and the parent are at odds in their decisions and many physicians lack the tools necessary to effectively navigate the conversation.

With greater publicity around fertility preservation for cancer patients, more patients and parents are becoming their own advocate and requesting information and services for fertility preservation even if their physician does not offer it.  However, the responsibility for conveying information about fertility preservation to patients lies in the hands of the medical professionals.  The ASCO Guidelines and subsequent QOPI measures are mechanisms to improve communication and ease the referral process.  New methods of communication strategies between physicians, parents, and patients must be identified and assessed and applicable training should be available to medial professionals on how to discuss fertility preservation with patients and their families.

Discuss communication strategies and troubleshoot barriers within your own home institution and refer back to Chapter 10, Fertility Communication to Cancer Patients: A Hematologist-Oncologist’s Perspective for talking points and references. Additional  resources can be found on the Online Resources section or Patient Resources section of the Oncofertility Consortium website

 

Tomorrow is International Childhood Cancer Day

Screen Shot 2014-02-14 at 2.04.05 PMTomorrow, February 15, 2014, is International Childhood Cancer Day.  A day devoted to the strength, courage and resiliency of children with cancer and their families.  The International Society of Pediatric Oncology (SIOP) and the International Confederation of Childhood Cancer Parent Organizations (ICCCOI) represent pediatric oncologists and childhood cancer parents’ organizations from countries around the world coming together for a common goal.  Every year more than 250,000 children are diagnosed with cancer with 90,000 dying from the disease when 70% of all childhood cancers are curable!

Screen Shot 2014-02-14 at 2.03.28 PMWhile adult cancers have benefited from new targeted drug therapies, childhood cancer drug development has lagged behind and children are receiving very strong drug doses that have many long-term effects.  These long-term effects are especially worrisome to the Oncofertility Consortium as they often relate to future fertility of childhood cancer survivors.  These cancer drugs save the life of patients but often eliminate the possibility for patients to have biological children when they are adults.  Research needs to progress quickly with simultaneous goals of identifying a cure for childhood cancer and eliminating the long-term side effects of cancer therapy on survivors.  We look forward to a day when cancer is no longer a concern and will work tirelessly to help the efforts in any way we can!  In the meantime, patients and their families can access a wealth of information at the Fertility Preservation Patient Navigator and  Oncofertility Consortium websites.

 

Virtual Grand Rounds on February 13, 2014

Screen Shot 2014-02-10 at 2.32.09 PMJOIN US! 

This Thursday, February 13th at 10am Central Time, the Oncofertility Consortium is proud to host our next Virtual Grand Rounds.  This presentation will be given by Dr. Robert E. Branningan and focus on Fertility Preservation in the Male: Optimizing the Delivery of Care.  Dr. Robert E. Brannigan is an Associate Professor of Urology, at Northwestern University.

 

To Attend Online:

  • On the day of the conference, login to participate beginning at 9:50 AM Central Time.
    • 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: Technical support is not available during the presentation)
  • Download the App to view this presentation on your iPad.
  • Test the computer you plan to use the day of the conference for compatibility.

To Attend in Person:

Come to the Robert H. Lurie Comprehensive Cancer Center, 303 E. Superior St., Suite 10-123, Chicago, IL 60611

View some of our previous Virtual Grand Rounds.

Communication Disparities

Screen shot 2013-10-30 at 4.09.44 PMThe next chapter in Oncofertility Communication: Sharing Information and Building Relationships across Disciplines addresses Disparities in Adolescent Patient-Provider Communication Regarding Fertility.  The authors, Amanda B. Fuchs and Dr. Robert E. Brannigan, provide detailed information regarding the disparities between providers and their adolescent patients even though in 2006 the American Society of Clinical Oncology (ASCO) published recommendations that oncologists should not only inform patients of the possibility of infertility as a result of cancer treatment, but must also discuss fertility preservation options with patients of childbearing age, including adolescents.  While the recommendations are available to oncologists, it is obvious that fertility preservation counseling services are still not reaching the adolescent patient population to the level needed.

Studies have shown that females are more likely than males to seek evaluation of fertility status but both males and females express regret for not having undergone fertility preservation prior to treatment.  But when dealing with adolescents, providers are in a difficult situation because adolescents have a wide range of understanding of fertility and are unlikely to initiate such a difficult discussion.  However difficult the conversation may be, the data shows that more than 90% of female oncology patients between 10-21 express a strong concern for their future and they (and their parents) would consider pursuing ‘research treatment’ as a way to preserve fertility as long as treatment was not delayed longer than 1 month.  While parents and adolescents may not be willing to delay treatment to undergo fertility preservation procedures, it is important that physicians inform patients and their families about long-term effects of cancer treatments and offer them the fertility preservation option so they may avoid regret down the road or feel they were mis-informed by their physician.

Screen Shot 2014-01-31 at 3.52.27 PMWhen dealing with adolescent patients, providers are often faced with the complicated task of discerning the physical and intellectual developmental stage of the patient before broaching the fertility preservation discussion.  This is important because the fertility preservation options that are available to post-pubertal patients are not always the same as those available to pre-pubertal adolescents.  Thus, it is necessary to create a paradigm that more clearly defines which patients are candidates for each fertility preservation option.  Some providers feel uncomfortable discussing fertility preservation with adolescents because it requires a basic understanding of sex and reproduction.  Training tools are necessary to assist physicians and nurses in the education of patients and their parents.

Beyond the difficulty discussing fertility preservation with patients, there are a myriad of ethical concerns that are brought to light when considering fertility preservation in adolescent.  Adolescents are not legally allowed to provide informed consent and must rely on the legal protection of their parents.  Older adolescents are able to provide informed assent (agreeing or disagreeing to the procedure or treatment) and the age of understanding varies between 9 and 14.  Nine year olds are less competent in understanding medical information but are able to demonstrate evidence of choice and reasonable outcome.  Fourteen year olds, on the other hand, have demonstrated a level of competency and informed decision making equal to adults.  While adolescents may not have the legal ability to make the decision, it is important for providers to acknowledge their awareness of their illness and make them feel empowered in the medical decision making process.

Chapter 9 of Oncofertility Communication reiterates the need for knowledge dissemination to providers in the medical field so they can adequately discuss fertility preservation options to the adolescent population and dispel communication disparities.  Please browse through the Oncofertility Consortium website to learn more about the resources available to adolescents and their parents.  You can also find more information at MyOncofertility.org, our Fertility Preservation Patient Navigator website, and SaveMyFertility.org.

2014 World Cancer Day

Screen Shot 2014-02-04 at 2.43.17 PMIf you’re not already aware, today is World Cancer Day.  World Cancer Day was founded by the Union for International Cancer Control (UICC) to support the goals of the World Cancer Declaration which calls upon government leaders and health policy-makers to significantly reduce the global cancer burden, promote greater equity, and integrate cancer control into the world health and developmental agenda.  The overarching goal of the Declaration is that there will be major reductions in premature deaths from cancer, and improvements in quality of life and cancer survival rates through nine major targets.

The World Health Organization released The World Cancer Report predicting that new cancer cases will rise from 14 million to 22 million between 2012 and 2020 and estimating an increase in cancer deaths during the same period from 8.2 million a year to 13 million.  These numbers demonstrate the growing need for policy-driven preventative public health policies.  The report indicates that approximately half of all cancers are preventable and could have been avoided if lifestyle factors such as drinking, smoking, diet and exercise were modified, if screening programs were implemented, or certain vaccines were given.  Lifestyle modifications will not prevent all cancer diagnoses and deaths, but it is clearly a step in the right direction and will allow for more focus and funding to be spent on spontaneous cancer diagnoses and the long term effects of treatment.  While the Oncofertility Consortium is dedicated to addressing the complex health care and quality-of-life issues that concern young cancer patients whose fertility may be threatened by their disease or its treatment, we look forward to the day when our work is obsolete.  Please join the Oncofertility Consortium in standing up in support of World Cancer Day!

Communicating Oncofertility to Children

978-1-4614-8234-5 (1)We’re jumping back into the chapter reviews of Oncofertility Communication: Sharing Information and Building Relationships across Disciplines.  Today, we’re reviewing Chapter 8, Communicating Oncofertility to Children: A Developmental Perspective for Teaching Health Messages by Dr. Ellen Wartella, Dr. Alexis Lauricella and Lisa Hurwitz.  Communicating health information as a whole, and especially reproductive health and sexuality, requires an understanding of what is developmentally appropriate for children.

Research has indicated that under the age of 7, children have very little understanding of the sexual function of genitalia, and only a rudimentary understanding of pregnancy occurring in the mother’s “stomach”.  Moving into middle school, there is more knowledge about terminology but confusion and uncertainty about reproduction and sexual activity.  Chapter 8 indicates that this aligns with the American Academy of Pediatrics Committee on Public Education which has shown that the majority of children and adolescents’ knowledge about sexuality comes from popular television and movies which rarely provide details about birth control, HIV, or other sexually transmitted diseases.

Screen Shot 2014-01-31 at 2.43.27 PMThankfully, progress is being made to create educational, curriculum-based television programs to address more specific issues relating to health as a whole and reproductive topics: Fizzy’s Lunch Lab, a PBS online website, provides an opportunity to teach children about healthy eating and Doc McStuffins, a Disney program about a child who pretends to be a doctor to her stuffed animals.  Beyond general health, Sesame Street co-productions have been successfully implemented to teach young children and families about specific area-related health messages.  For example, in South Africa in 2001, here was a very high rate of HIV infection and considerable stigma associated with the disease.  Takalani Sesame was created and introduced an HIV-positive character, Kami, to teach young children basic health and social information about HIV/AIDS and demonstrated improvement in children’s basic knowledge about HIV/AIDS, blood safety, destigmatization and coping with the illness.

Puppets and dolls have also been used to convey medical information to children and adolescents, but video recordings of puppets and dolls are the easiest way to standardize the transmission of educational information that can reach far beyond hospital and medical office walls to reach a wider audience.  Experts are offering suggestions on how to choose and tailor the above techniques depending on the age of targeted children.  Information needs to be simplified using age-appropriate terminology and descriptions and including the use of tactile components if designing interventions for very young children.

Read Chapter 8 of Oncofertility Communication: Sharing Information and Building Relationships across Disciplines and continue reading below for exciting new research being done by authors Wartella and Lauricella.

Screen shot 2014-01-23 at 3.52.46 PMThe Oncofertility Consortium prides itself on reaching across medical and educational disciplines to create and support robust and applicable materials for use by both clinicians and the public.   As such, the Oncofertility Consortium is excited to announce work being done in The Center on Media and Human Development within the School of Communication at Northwestern University under the direction of Dr. Ellen Wartella.

The Center on Media and Human Development is dedicated to training future researchers to conduct research in the field of human development and media.   Dr. Wartella and Dr. Alexis Lauricella are working on a project to help researchers understand what children, and their parents, think about reproductive health.  This will be done through an IRB-approved study asking parents and children to attend at a focus group at Northwestern University.  Learn more about the project, IRB #89306: Children’s Understanding of Reproduction Health and Parent’s Beliefs About Reproduction Health Education, at the CMHD website.

Please contact Dr. Lauricella at cmhd@northwestern.edu with any questions or concerns.  We look forward to learning about the data gathered during the study focus groups.

To learn about Oncofertility Consortium research projects, feel free to explore the research listings on the Oncofertility Consortium website.

Global Partner: Portuguese Centre for Fertility Preservation

The Oncofertility Consortium is happy to welcome the Portuguese Center for Fertility Preservation as a Global Partner.  We currently work with reproductive specialists from all over the world in an effort to better serve children, adolescents and young adults with cancer and other fertility-threatening diseases.  Learn more about the Portuguese Centre for Fertility Preservation below.

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The Portuguese Centre for Fertility Preservation (in the Human Reproduction Service of the Coimbra Hospital and University Centre) is the only public centre of the country and it was created in 2010 to fulfill the reproductive needs of patients undergoing treatments possibly threatening to their reproductive function. In Portugal, the male fertility preservation is done since the 90’s in several public institutions. However, the female fertility preservation techniques weren’t available before in the Portuguese public practice. So it was clearly important to do something to try to assure the biological parenthood of the female patients too.

Since 2010, our main goal is to provide reproductive monitoring and counseling to male and female patients from every part of the country that are undergoing  possibly gonadotoxic treatments. Through a multidisciplinary approach, we try to support the decision-making process of the patients about the preservation of their fertility and, whatever the decision made by the patient, we try to support their reproductive decisions after the end of the treatments, throughout annual follow-up consultations.

Although most of the cancer patients are referred to the Centre by their oncologists, it is important to note that a significant number of them asks for a consultation by their own. However, the opportunity to make a decision about fertility preservation is stated by all cancer patients as crucial, regardless they were referred by the oncologist or not. Patients tell us how important it is for them to receive information not only about the disease or the immediate effects of the treatments, but also about how to try to protect their parental project. This gives them hope, and some sense of control in a context of truly uncontrollability.

Therefore, another goal of our Centre is to try to better inform patients, health professionals and general population about the impact of cancer in fertility, the techniques of fertility preservation and how to reach our team. To achieve this goal we are working in several ways. Firstly, we have already developed some written information for the patients that are assisted in our Centre (and these patient fact sheets have been anonymously evaluated by the patients as very useful for their decision-making process). Secondly, some team members are developing research (with funding by the Portuguese League Against Cancer and Celgene® – ref. LPCC/Celgene2013 – and by the Foundation for Science and Technology – ref. SRFH/BD/84677/2012) to try to better understand the information needs and the attitudes of the cancer patients and the oncologists about fertility preservation. Thirdly, we have organized our first course about fertility preservation for health professionals in October 2013, in the 5th Portuguese Congress of Reproductive Medicine, with the paticipation of Professor Teresa Woodruff, M.D., Ph.D. Lastly, we are developing our own website with some information specifically designed to health professionals and other specific information to patients and public population.

Thus, the Portuguese translation of the SaveMyFertility application will help us achieving this goal. On one side, it will better support the information presented in our website and then it will help us informing the patients, health professionals and general population to get more information about this theme. On the other side, it will be important in our clinical practice, as we will explore the application with the patients at the decision-making process about fertility preservation and we will recommend them to consult it profoundly at home and come back to us for any doubt. This way, the patients are guided to have access to well done and organized information in a specific and recommended tool.

The Portuguese Centre for Fertility Preservation team is coordinated by Professor Teresa Almeida Santos, M.D., Ph.D., director of the Human Reproduction Service of Coimbra Hospital and University Centre and professor of the Faculty of Medicine of University of Coimbra. It is constituted by:

  • Four doctors, full time members of Human Reproduction Service of Coimbra Hospital and University Centre;
  • One doctor, full time member of Gynecology Service of Coimbra Hospital and University Centre;
  • One biologist, full time member of Human Reproduction Service of Coimbra Hospital and University Centre;
  • One psychologist, Ph.D. student from the Faculty of Psychology and Educational Sciences of University of Coimbra and member of the Unity of Psychology Intervention of the Maternity Dr. Daniel de Matos of Coimbra Hospital and University Centre;
  • One pharmacist, Ph.D. student from the Faculty of Pharmacy of University of Coimbra.

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The Oncofertility Consortium is excited to welcome another Global Partner to our group.  For more information about the Portuguese Centre for Fertility Preservation or our other Global Partners, please review out the Oncofertility Consortium‘s Global Partner webpage.

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