I recently ran across an article by Fiona Macrae written on October 29, 2009 from Mail Online entitled “No men OR women needed: Scientists create sperm and eggs from stem cells”. I proceeded to read this article before I read the actual scientific manuscript that it was based on; the article itself makes several very big claims: 1) the research could change the face of parenthood, 2) the research could be the cure for infertility and 3) it may soon be possible for children to be born through entirely artificial means. For the last few years, there have been several outrageous media outlets that make a practice of taking an interesting scientific manuscript and sensationalizing it as a cure for infertility, etc.

Egg and Sperm Image: Alison Kim

I continued on and read the original scientific paper they were describing in the column, “Human DAZL, DAZ and BOULE genes modulate primordial germ-cell and haploid gamete formation;” an article published in this month’s issue of Nature. It truly is a super paper describing the role the DAZL, DAZ, and BOULE genes play in the progression of embryonic stem cells to primordial germ cells (PGCs) and the subsequent development into a haploid gamete. Interestingly, this group isolated fluorescently-tagged PGCs that were developed from embryonic stem cells in culture (previously shown), but for the first time demonstrated that DAZL, DAZ, and BOULE are upregulated in order to induce these PGCs to begin meiosis and then arrest at early prophase of meiosis I.

What the scientific paper did not describe, or even hint at, was that this science would be a cure for infertility.  What this paper does, however, is attempt to clarify another step in the process of early germ cell formation that may be used as a tool for elucidating critical steps in male and female infertility. There is not one simple solution to infertility. I urge all scientists and non-scientists to be objective about outrageous claims that are made about cures and answers and to read the actual scientific papers and find the true messages behind the science.

Every summer, Teresa Woodruff sends out a summer reading list to the people in her lab. Because there isn’t much of a global perspective on Oncofertility yet, this year’s theme is “Global Perspectives on Reproduction” to prepare, hopefully, to create partnerships with the World Health Organization and other global health organizations.

The reading list will provide a foundation and an entry-point into the existing literature and includes some of the recent papers from the Oncofertility Consortium and, of course, the Oncofertility book by Teresa Woodruff (recently reviewed in the journal Fertility and Sterility — see blog entry dated June 4th).

Here is a copy of Teresa’s list:

1. Woodruff, Teresa K. and Snyder, Karrie Ann Sr.  Oncofertility: Fertility Preservation for Cancer Survivors.  Springer, 2007.

2. Inhorn, Monica C and Van Balen, Frank.  Infertility Around the Globe: New Thinking on Childlessness, Gender, and Reproductive Technologies.   University of California Press, 2002.

3. Ginsburb, Faye D and Rapp, Ranya.  Conceiving the New World Order: The Global Politics of Reproduction.  University of California Press, 1995.

4. Edwards, Jeanette; Franklin, Sarah; Hirsch, Eric; Price, Francis; and Strathern, Marilyn.  Technologies of Procreation: Kinship in the Age of Assisted Conception.  Routledge, 1999.

5. Ellison, Peter T.  On Fertile Ground: A Natural History of Human Reproduction.  Harvard University Press, 2001.

6. Runowicz, Carolyn D., Petrek, Jeanne A. and Gansler, Ted S.  Women in Cancer: A Thorough and Compassionate Resource for Patients and Their Families.

7. Heiney, Sue P., Hermann, Joan F., Bruss, Katherine V., and Fincannon, Joy L..  Cancer in the Family: Helping Children Cope with a Parent’s Illness.  2001.

8. Eyre, Harmon J., Lange, Diane Partie, and Morris, Lois B.  Informed Decision: The Complete Book of Cancer Diagnosis, Treatment, and Recovery.   Viking, 1997.

9. Shenfield, Francoise and Sureau, Claude.  Contemporary Ethical Dilemmas in Assisted Reproduction.  Informahealthcare, 2006.

The American Society for Reproductive Medicine published a review of “Oncofertility: Fertility Preservation for Cancer Survivors” in the May 2009 volume of its journal Fertility and Sterility.

Cover of the Oncofertility book reviewed by Dr. Jared Robins in the journal Fertility and Sterility

Some exerpts from the review by Dr. Jared Robins, Brown University:

• “Oncofertility is a term recently coined by this book’s editor, Teresa K. Woodruff.”
• “In the first chapter of this book, the authors estimate that there are currently over 630,000 young cancer survivors and more than 12,400 are diagnosed each year.”
• “Overall, this book is a comprehensive review of all aspects of the new field of oncofertility. The book is divided into five sections, each devoted to educating the reader about an important aspect of this emerging field.”
• “The concluding chapter is a compilation of stories about real patients’ experiences with fertility and cancer. I commend the editors for including this section because it ties each of the disciplines together with important patient experience.”

To read the entire review, you will need access to Fertility and Sterility through your personal, work, school or library membership: Oncofertility: Fertility Preservation for Cancer Survivors.

The MyOncofertility Web site is now listed on The Hormone Foundation’s Web site in the “Useful Links” section, under the Public/Patients tab.

The Hormone Foundation is a rich source of hormone-related health information and targets for not only doctors and organizations, but patients and the general public too.

The MyOncofertility site will now be an addred resource for those people seeking information, and can help the Foundation uphold its mission “to serve as a resource for the public by promoting the prevention, treatment and cure of hormone-related conditions through outreach and education.”

The Foundation works directly with The Endocrine Society and its members to make information about hormones and endocrine diseases readily accessible and available to everyone.

To check out the page with the MyOncofertility Web site link, go to: Useful Links.

On March 10th, Time Magazine published an article that mentioned both Dr. Silber, a member of the Oncofertility Consortium, and a journal article published in the New England Journal of Medicine.

A Hope to Prolong Fertility: Ovarian Transplants describes the choices faced by Stephanie Yarber, one of Dr. Silber’s patients. Yarber was diagnosed with premature ovarian failure at 14 and opted to try an ovarian transplant.

The article also mentions “Preservation of Fertility in Patients with Cancer” by Dr. Jeruss and Teresa Woodruff.

Cancer is now a disease with a variety of treatment options, which are leading to longer and more productive lives by survivors. Globally, there are 10 million people diagnosed with cancer.  10% of these newly diagnosed men and women are under the age of 45 years old. Infertility can be a consequence of many of the more aggressive chemo- and radiation therapies that prolong and save lives.  The ability to easily preserve sperm prior to cancer treatment provides hope at the time of diagnosis and families later in life for male survivors.  A notable example is Tour de France winner Lance Armstrong who has three children conceived using sperm frozen days before he underwent the massive chemo- and radiation therapy that saved his life. Unlike sperm, the female germ cell, the oocyte or egg must be retrieved surgically.  Moreover, the vast majority of collected oocytes will be immature and cannot be used immediately by a woman who is ready to start a family.  The overall hypothesis  of the program is that effective fertility-extending options can be provided to young women undergoing life-preserving cancer treatment. The purpose of our work is to bring physicians, medical ethicists, social scientists and basic scientists together to develop new strategies for fertility preservation for female cancer survivors under the new discipline of oncofertility.  And even as the lexicon is being established, complex bioethical issues face both providers and parents.  At the basic science level, complex issues of ovarian function and preservation must be addressed including the problem of follicle growth and development in vitro. Our investigative group has pioneered the development of a 3-dimensional system that supports follicle development, largely, we believe, because the links between the egg and its surrounding cells are maintained.  Using a tissue-engineered approach, we have developed an in vitro follicle growth system that supports the maturation of the enclosed oocyte, which can be fertilized and results in live, healthy and reproductively competent mice.  The goal of our program and the broader Oncofertility Consortium is to explore and expand the reproductive options available to young people facing a fertility-threatening but life-preserving cancer treatment.

Hi, my name is Dr. Jennifer Hirshfeld and I am an ob/gyne currently undergoing subspeciality training in reproductive endocrinology and infertility.  As part of this program, I have had the opportunity to work in Dr. Woodruff’s lab and learn about the emerging scientific discoveries regarding ovarian biology.  Oncofertility focuses on fertility preservation for cancer patients as treatments as well as the disease can affect one’s future fertility.  Yet, cancer is not unique in this way; other disease processes have treatments that also effect one’s future fertility.  I plan to focus this blog on coverage of some of those diseases with suggested articles and websites to learn more about this important topic.  It is very exciting to be apart of the oncofertility focused “blog-society”!  I look forward to your comments and suggestions.