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New Hope to Preserve Fertility After Transplant
Contributing writer: Maribeth Allen
Many women are overwhelmed by the prospect of infertility after transplant. Now, investigators are trying to determine whether a new procedure may enable more women to bear their own biological child after transplant.
The investigational procedure, called ovarian tissue cryopreservation (freezing), is being explored at a few fertility clinics in the US. The woman’s ovary is removed laparoscopically, using a small telescope-like instrument, and frozen before cancer treatment. The hope is that the frozen ovarian tissue can later be used to initiate pregnancy after cancer treatment. Ovarian tissue cyropreservation is the female equivalent of sperm banking, but more complicated.
“This minimally invasive, low-risk procedure takes less than an hour and requires only a few hours in out-patient recovery,” says Teresa K. Woodruff MD, who heads the Institute for Women’s Health Research at Northwestern University’s Feinberg School of Medicine in Chicago, where the procedure is being performed. Patients can return to normal activity or begin chemotherapy or radiation treatment within two to three days. Eighty percent of the ovary is frozen for the patient’s future use and 20 percent is saved for research.
“The predominant reaction I receive is an overwhelming sense of relief that fertility preservation options are available to women and girls,” says Laxmi Kondapalli MD, who works with the program.
Gayle Meyer, a 27-year-old nurse, has utilized this new technology. Before beginning cancer treatment for Hodgkin’s lymphoma, Meyer decided that ovarian tissue freezing offered her the best chance at future fertility.
Now, recovered and actively pursuing a nursing degree, Meyer’s outlook is two-fold. “Not only is it exciting to know that I might be able to have children when the time is right, it is rewarding to contribute to research and give back to the medical community.”
Meyer’s advice to other females in a similar situation is “Don’t be shy to discuss your fertility with your oncologist. Be referred to a fertility specialist. Find out your fertility preservation options even if you are not sure about wanting children. Keep an open mind and remain positive.”
Dr. Woodruff recently introduced the fertility preservation program to female children and adolescent cancer patients at Children’s Memorial Hospital in Chicago. Patients between the ages of one to 21 are eligible for ovarian tissue cryopreservation. The program also offers post-pubertal male cancer patients the opportunity to sperm bank.
While the procedure offers hope to patients, it is still in the investigational phase. To date, research has yielded pregnancies in mice, and investigators are hoping it will be effective in humans as well.
“This work is something to be passionate about,” says Woodruff. “As survival rates for cancer patients improve, long-term considerations emerge to the forefront. Survivors report that the impact of cancer treatment on their fertility is an important issue both at the time of diagnosis, and later.”
Much is still unknown about exactly how chemotherapy and radiation affect fertility. Other approaches to protecting a woman’s fertility are being explored. These include ovarian transposition, where the ovaries are moved away from the radiation field, and GnRH analog treatment, where hormones are given to create temporary menopause. Some women may have children with in-vitro fertilization, using either their own egg that was collected prior to cancer therapy or donor eggs. However, each approach has had limited success.
The Fertility Preservation program developed at Northwestern University serves as the model for the National Physicians Cooperative to Preserve Fertility for Female Cancer Patients—an alliance of twenty academic medical centers working to improve fertility options for patients after cancer therapy. All are in the process of establishing ovarian tissue cryo-preservation programs. For more information about the Ovarian Tissue Freezing study at Northwestern University or the National Physicians Cooperative call 312 695-1156 or go to www.cancer.northwestern.edu/fertilitypreservation/index.cfm.
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