Oncofertility Publications - Oncofertility and Fertility Preservation

Köhler TS, Kondapalli LA, Shah A, Chan S, Woodruff TK, Brannigan RE. J Assist Reprod Genet. 2010 Nov 26.

Purpose: Diminished reproductive capacity is a devastating consequence of life-sparing therapies for childhood malignancy. In 2006, the American Society of Clinical Oncology (ASCO) published fertility preservation recommendations (ASCOR) emphasizing the importance of early discussion and intervention for fertility preservation strategies. Using the Survey for Preservation of Adolescent REproduction (SPARE), we sought to determine fertility preservation attitudes and practice patterns post-ASCOR from pediatric oncology specialists nationwide.

Materials and methods: The SPARE survey consists of 22 questions assessing pediatric oncology specialists’ attitudes and practice patterns toward fertility preservation. Broad perspectives on fertility preservation, including a willingness to discuss fertility, knowledge of current fertility preservation methods and awareness of ASCOR, were assessed.

Results: The majority of respondents acknowledged that fertility threats are a major concern for them and agreed that all pubertal cancer patients should be offered a fertility consultation, but only 46% reported they refer male pubertal cancer patients to a fertility specialist prior to cancer treatment >50% of the time, and only 12% reported they refer female pubertal cancer patients to a fertility specialist prior to cancer treatment > 50% of the time. While 44% of respondents were familiar with the 2006 ASCOR, only 39% of those utilized them to guide decision-making in greater than half of their patients. 

Conclusion: Our study demonstrates pediatric oncologists’ motivation to preserve fertility in pediatric cancer patients; however, barriers to both gamete cryopreservation and referral to fertility specialists persist. Female pubertal patients are referred to fertility preservation specialists with much less frequency than are male pubertal patients, highlighting a disparity.

Woodruff TK. Preserving fertility during cancer treatment. Nat Med. 2009 Oct;15(10):1124-5. 

Abstract

Increases in the number of adult cancer survivors and other issues have forced the oncology community to examine, evaluate, and alter the cancer care paradigm. Pediatric oncologists are grappling with the task of transitioning a growing population of adult survivors of childhood cancer to adult medicine, while oncologists caring for adult cancer survivors are seeking models of follow-up care that are acceptable to patients and providers. Workforce and access-to-care issues suggest that primary care providers will see more cancer survivors in their practices across time, although it is unclear how prepared they are for this task. Translational research is needed to develop evidence-based clinical care and survivorship care plans. A broad picture of the evolving field of adult cancer survivorship is presented. The recent focus on young adult survivors of childhood cancer, an overview of translational research needed to inform the physical and psychosocial care of cancer survivors, and the roles of primary and specialty care providers managing this population is examined. Finally, an overview of evolving treatment summary and care plan initiatives is presented.

Jacobs LA, Palmer SC, Schwartz LA, DeMichele A, Mao JJ, Carver J, Gracia C, Hill-Kayser CE, Metz JM, Hampshire MK, Vachani C, Pucci D, Meadows AT. CA Cancer J Clin. 2009 Nov-Dec;59(6):391-410.

Abstract

OBJECTIVE: To articulate the need for a new approach to primary ovarian insufficiency. The condition, also known as premature menopause or premature ovarian failure, is defined by the presence of menopausal-level serum gonadotropins in association with irregular menses in adolescent girls or women younger than 40 years. It can be iatrogenic as related to cancer therapy or may arise spontaneously, either alone or as part of a host of ultrarare syndromes. In a large percentage of spontaneous cases no pathogenic mechanism can be identified.

DESIGN: Literature review and consensus building at a multidisciplinary scientific workshop.

CONCLUSION(S): There are major gaps in knowledge regarding the etiologic mechanisms, psychosocial effects, natural history, and medical and psychosocial management of primary ovarian insufficiency. An international research consortium and disease registry formed under the guidance of an umbrella organization would provide a pathway to comprehensively increase basic and clinical knowledge about the condition. Such a consortium and patient registry also would provide clinical samples and clinical data with a goal toward defining the specific pathogenic mechanisms. An international collaborative approach that combines the structure of a patient registry with the principles of integrative care and community-based participatory research is needed to advance the field of primary ovarian insufficiency.

Amber R. Cooper, MD, Valerie L. Baker, MD, Evelina W. Sterling, PhD, Mary E. Ryan, MLS, Teresa K. Woodruff, PhD, and Lawrence M. Nelson, MD.  Fertility and Sterility, 2010.

Abstract

Children and women of reproductive age are increasingly surviving cancer diagnoses, and therefore long-term quality-of-life issues are of greater importance at the time of diagnosis. Cancer therapies including radiation and chemotherapy can be detrimental to fertility, and therefore many patients are motivated to preserve fertility prior to cancer treatment. The only highly successful method in preserving fertility to date is embryo cryopreservation, which may not be appropriate for some patients due to age, delay in treatment, cancer type and stage, as well as availability of an acceptable sperm donor. Alternative methods including oocyte cryopreservation and ovarian tissue banking may also preserve fertility while providing additional flexibility to patients. In vitro ovarian follicle maturation following tissue banking is one potential approach that would not require a delay in cancer therapy for ovarian stimulation, would not require an immediate sperm donor, and does not carry the risk of reintroducing malignant cells following tissue transplantation. In vitro follicle culture systems have resulted in successful live births in the mouse. However, many challenges must be addressed in translating the system to the human. This review summarizes current approaches to fertility preservation and discusses recent developments and future challenges in developing a human in vitro follicle culture system.

Erin R. West, PhD, Mary B. Zelinski, PhD, Laxmi A. Kondapalli, MD, Clarisa Gracia, MD, Jeffrey Chang, MD, Christos Coutifaris, MD, PhD, John Critser, PhD, Richard L. Stouffer, PhD, Lonnie D. Shea, PhD, and Teresa K. Woodruff, PhD; Pediatr Blood Cancer 2009;53:289–295

Jacqueline S. Jeruss and Teresa K. Woodruff; New England J. Med. Vol 360 No 9 902-911 Feb 26 2009.

The unique duality involved in confronting a life-threatening diagnosis while simultaneously considering the deeply human desire to have a child presents a struggle both for patients with cancer and for clinicians. Yet with improved survival rates among young patients with cancer, recent bench to-bedside translation of new techniques to preserve fertility, and increased awareness of choices for the preservation of fertility, options for family planning are now being offered to patients who have received a diagnosis of cancer. Concerns about fertility are similar for men and women; however, their opportunities for intervention differ considerably. This review describes current and emerging options for the preservation of fertility in patients with cancer and provides a conceptual framework for managing concerns about fertility at the time of diagnosis