Related story: Patients of all ages
As the number of young and adult cancer survivors of childbearing age increases due to progress in oncology, the adverse effect on reproductive function assumes greater importance.
The good news, according to Anna Franklin, M.D., assistant professor in MD Anderson’s Department of Pediatrics, is that techniques to harvest and store reproductive cells have vastly improved in the last several years.
“Fertility preservation is still an emerging discipline,” Franklin says, “but rapid advances in technology now provide new options for patients.”
Freezing sperm remains a stable and reliable technique while recent advances in assisted reproduction technology have revolutionized the options available for women. The major advancement is a new method of freezing oocytes (eggs) called vitrification that avoids the damage caused by ice crystal formation within the eggs.
The American Society of Reproductive Medicine now considers this technique standard procedure, though it still has limited application.
One scientific challenge is cultivating and storing sperm and egg tissue from prepubescent cancer patients. Boys do not produce sperm until they go through puberty, and girls’ ovaries may not respond to hormone stimulation required to harvest eggs. Studies for both are ongoing.
“The hope is that the tissue could be used later in patients’ lives to create pregnancies,” Franklin says. “But we need to make sure we do not re-implant cancer cells along with the reproductive tissue.”
One of the most important remaining hurdles is educating patients about the available options for fertility preservation at the same time they learn about the cancer diagnosis and the treatment that lies ahead of them. Patients need to be referred to infertility specialists familiar with the unique time constraints a cancer patient faces and who have credible experience with the various options.
Timing is of the essence, Franklin notes. “Fertility preservation treatments can take two to three weeks, and it’s better to take the steps before cancer care begins.
Fortunately, Dr. Terri Woodard, a board-certified fertility specialist, recently joined our faculty to address this significant need of our young patients and survivors.”