Preserving Fertility for Life After Cancer
March 4, 2009 — It may be hard to do when first diagnosed, but many young people facing cancer should look beyond their treatment to a long life that may include children. Options have existed for some time for individuals to plan for fertility after cancer treatment, but a promising new technique holds hope for those patients for whom traditional methods aren’t an option.
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TRANSCRIPT OF AUDIO FILE
On this edition of Cancer Connection, we’ll talk about fertility after cancer and new procedures offering hope for those wanting to start a family.
Host: Thanks for downloading this podcast from the Siteman Cancer Center at Barnes-Jewish Hospital and Washington University's School of Medicine in St Louis. I’m Jason Merrill. Infertility is a common complication of cancer therapy in young women. While there are many treatment options, new procedures like ovarian tissue cryopreservation help patients start families after their cancer treatment. To tell us more is Emily Jungheim. She is a reproductive endocrinologist at the Washington University Infertility and Reproductive Medicine Center at Barnes Jewish Hospital. Dr. Jungheim, thank you for joining us.
Jungheim: Thank you very much. It's good to be here.
Host: What is ovarian tissue cryopreservation?
Jungheim: Ovarian tissue cryopreservation is a procedure where we remove ovarian tissue from a patient who is going to be facing a gonadotoxic therapy and would like to preserve her fertility. We remove the tissue, and we actually freeze it and store it until the patient is ready to use it for her own reproductive use. It’s experimental right now – there have only been a handful of pregnancies that have resulted from frozen ovarian tissue. There's a lot of research going on right now to determine how to improve the use of ovarian tissue and different ways to use ovarian tissue to increase a patient's chances of getting pregnant from that actual tissue and the eggs that are contained in that tissue.
Host: So how is this technology different from standard methods of fertility preservation?
Jungheim: That's a great question. As I mentioned, this is experimental. There have only been a handful of pregnancies across the world that have resulted from frozen ovarian tissue. But it’s important to keep in mind that in vitro fertilization wasn’t even possible 35 years ago. That involves fertilizing eggs with sperm outside of the body and putting them back. So this technology does advance rapidly, and for a young patient, it could be a viable option when she's actually ready to use the ovarian tissue for having a child. If we have time, if we have a patient who's facing therapy or a disease that's going to threaten her fertility, the standard way to help the patient would be either to bank eggs or bank embryos if she has a partner from whom we can get sperm. Ovarian tissue cryopreservation is really reserved for patients who are either prepubertal, so girls who cannot go through a procedure to retrieve eggs, or for patients who don't have time to go through our standard methods of fertility preservation, including egg banking and embryo banking. That would include patients with leukemia and other acute diagnoses, patients who are having their ovaries removed for another indication, such as endometrial cancer, or something along those lines.
Host: You had mentioned with cryopreservation, there had only been a handful of successful pregnancies. How far do you see this option going in the future?
Jungheim: The thing to keep in mind is a lot of these patients who have frozen tissue haven't come back to use that tissue yet. So really, with ovarian tissue cryopreservation, the first case was probably within the last five years or so where a woman actually got pregnant from the frozen tissue. Since then, a lot of women have come through and frozen tissue across the country and across the world, but a lot of these women haven't overcome their diagnosis yet, haven't finished treatment or aren’t ready to have kids. So it may be that when these women start coming back to actually use the tissue, we will see more pregnancies. Traditionally in the cases I mentioned that have been reported, they've actually taken the ovarian tissue that was frozen and put it back into the patient's pelvis, and then they’ve ovulated spontaneously and gotten pregnant that way. There have been some reports where they've isolated eggs from that frozen tissue and then fertilized them in vitro. That's where a lot of the research is going right now. And as I said, as more of these women come back and want to use that tissue, hopefully the technology will show a lot more promise than it has in more recent years.
Host: When someone is diagnosed with cancer at a young age, they’ve got a lot going through their mind to begin with, but having children is obviously part of that. At what point should a young person diagnosed with cancer start thinking about preservation?
Jungheim: We’d really love to see them as soon as they get their diagnosis. We need to work closely with their oncologist and their surgeon, if there’s a surgeon involved, so that we can determine what course of therapy they’re going to get and figure out exactly how we think that may affect their fertility. Any time somebody is going to be getting chemotherapeutic agents that may affect their gonadal function or is going to be undergoing surgical therapy that’s going to remove their ovarian tissue or testicular tissue, they really should be thinking about this. Anybody who’s premenopausal and who’s going to be facing treatments or a disease that’s going to affect fertility, if they’re concerned, we would love to see them as soon as possible so that we can be sure we have the optimal amount time to actually do something about it.
Host: Overall, it’s very successful for people who have been diagnosed with cancer to bank embryos or sperm and have children later, correct?
Jungheim: If a patient wants to bank embryos, that's kind of the standard care. That's not considered experimental. We do that all the time for regular infertility patients. We freeze excess embryos and have patients come back to use those. You know, a lot of it depends on what age the patient is diagnosed at. As women get older, their fertility goes down, and we may not get as many embryos back from a woman who’s older as compared to somebody who’s younger, in their teens and twenties, something like that. But overall, our success rates for having a patient come through with frozen embryos are pretty good. We have another protocol here at Washington University looking at freezing eggs from patients if they don't have a partner. That's also considered experimental, and we don't have a lot of numbers to show what our success rates are for that. But overall, banking for cancer patients is very successful because it's no different than just a normal couple with infertility who banked embryos.
Host: We focused on women and banking that tissue, but men can bank sperm as well, correct?
Jungheim: Absolutely. And a lot of times, men will find after their treatment that their sperm counts have returned, and they may not need to keep that sperm there, but it’s an easy enough thing to do. We do it all the time, and if you do need it in the future, you know that it’s here for you and that it works very well, depending on what the counts are, for either insemination or in vitro fertilization. And for guys who have really low counts, we can actually inject each individual egg with a sperm to make sure that person has a chance of having his own biological child.
Host: Dr. Jungheim, thank you for joining us.
Jungheim: Thank you very much. It’s been a pleasure.
Host: For more information, you can visit Dr. Jungheim and her colleagues online at www.infertility.wustl.edu. Or for more cancer information, you can visit www.siteman.wustl.edu. Thanks for downloading. Until next time, I’m Jason Merrill.