Oncofertility Education Modules: A presentation by Dr. Hananel Holzer

Oncofertility Education Modules: A presentation by Dr. Hananel Holzer:


Resident Module – Fertility#1
Resident Module – Fertility#2a
Resident Module – Fertility#2b

Resident Module – Fertility#3


by Monisha Sudarshan, MD
As one walks into Dr.Holzer’s office, his passion and love for helping patients with fertility issues is clear. Among the many honors and thank you notes, sits a small decorative baby carriage with the words engraved “Doctors are known to heal, you are known to create miracles”. Dr. Holzer is the Medical Director of the MUHC (McGill University Health Centre) Reproductive Centre and one of the pioneers in oncofertility. In fertility management, he describes every couple as a “new story” however, oncofertility presents its own unique challenges and complexities for the patient and physician population. Dr.Holzer advises his patients that the first and foremost importance is to fight the cancer; fertility represents an important aspect but is not the primary priority. One of his goals is also to educate and bring awareness to cancer physicians and residents about the options of fertility preservation for the younger oncology population and is working on creating easy, timely access for referral of these patients to expert centers. Continuing his educational endeavour, he has designed expert teaching modules targeted for resident education in oncology and fertility and to spark interest in this interesting and rapidly growing field. Modules begin with basic physiological changes with chemotherapy and radiotherapy, progress to current options in fertility preservation and the experience at the McGill University Health Center. Continue to stay tuned for more knowledge on this important and stimulating topic within oncology.

WebMD - Future Fertility Fix? Egg-Producing Stem Cells Found in Human Ovaries

"....Scientists say they have found a way to use ovarian stem cells to perhaps one day help infertile women get pregnant -- or add years to a woman’s reproductive cycle.
In a study published in Nature Medicine, researchers report finding egg-producing stem cells in human ovaries. They also report being able to make some of those ovarian stem cells grow into immature eggs that may someday be useful for reproduction.
At this point, such “seed” eggs can’t be fertilized by sperm. But if scientists are able to entice them to mature and can prove they can be fertilized and grow into embryos -- a feat that has been reported in mice -- it would overturn a long-held scientific belief that women can’t make new eggs as they get older.
“What it does is really open a door into human reproduction that 10 years ago didn’t even exist,” says researcher Jonathan L. Tilly, PhD, director of the Vincent Center for Reproductive Biology at Massachusetts General Hospital, in Boston....."

abstract: Pregnant woman with an extremely small uterus due to pelvic irradiation in childhood (very sad)

Pregnant woman with an extremely small uterus due to pelvic irradiation in childhood:

Abstract

"A female cancer survivor, having suffered malignant lymphoma during childhood and received radio- and chemotherapy, became pregnant. Her uterus was extremely small and in the 22nd week of gestation, acute uterine contractions occurred, leading to preterm delivery and resulting in the death of the infant. Pelvic irradiation in childhood was considered to have caused a small uterus and thus brought on preterm delivery. The younger the patient, the more vulnerable the uterus is to irradiation. The exposure dose to the uterus in pediatric cancer patients should therefore be reduced, especially in younger patients. The cooperation of pediatric cancer specialists and obstetricians is necessary to preserve the future fertility of female cancer survivors."

abstract: Fertility preservation in gynaecological cancer: Epithelial ovarian cancer.

Best Pract Res Clin Obstet Gynaecol. 2012 Jan 24. [Epub ahead of print]

Abstract
The incidence of epithelial ovarian cancer in women aged 40 years and younger is 3-17%. The management of these women is challenging and requires balancing the need to treat epithelial ovarian cancer adequately and preserving reproductive potential. Fertility-sparing surgery, especially for early stage epithelial ovarian cancer, seems to be associated with equivalent clinical and cancer outcomes while preserving reproductive potential. A complete staging and cytoreductive procedure retaining the uterus, and at least one grossly normal ovary, is the minimum recommended procedure. Adjuvant chemotherapy with a platinum-taxane combination is recommended as clinically indicated, and is associated with better cancer and survival outcomes. Adjuvant treatment does not seem to increase the risk of congenital anomalies in subsequent pregnancies. Targeted therapy and ovarian cryopreservation are largely experimental and cannot be recommended as part of the clinical standard of care.

abstract: Chemotherapy and fertility

Best Pract Res Clin Obstet Gynaecol. 2012 Jan 24. [Epub ahead of print]

Abstract

The overall increase in cancer prevalence and the significant increase in long-term survival have generated worldwide interest in preserving fertility in young women exposed to gonadotoxic chemo- and radiotherapy. Infertility represents one of the main long-term consequences of combination chemotherapy given for lymphoma, leukaemia and other malignancies in young women. The gonadotoxic effect of various chemotherapeutic agents is diverse, may involve a variety of pathophysiologic mechanisms, and is not unequivocally understood. Proliferating cells, such as in tissues with high turnover (i.e. bone marrow, gastrointestinal tract and growing ovarian follicles) are more vulnerable to the toxic effect of alkylating agents. These agents may also be cytotoxic to cells at rest, as they are not cell-cycle specific. Alkylating agents, the most gonadotoxic chemotherapeutic medications, cause dose-dependent, direct destruction of oocytes and follicular depletion, and may bring about cortical fibrosis and ovarian blood-vessel damage. The reported rate of premature ovarian failure after various diseases and chemotherapeutic protocols differ enormously, and depend mainly on the chemotherapeutic protocol used and age range of the woman. 

Several options have been proposed for preserving female fertility, despite gonadotoxic chemotherapy: ovarian transposition, cryopreservation of embryos, unfertilised metaphase-II oocytes and ovarian tissue, and administration of gonadotropin-releasing hormone agonistic analogs in an attempt to decrease the gonadotoxic effects of chemotherapy by simulating a prepubertal hormonal milieu.

None of these methods is ideal and none guarantees future fertility in all survivors; therefore, a combination of methods is recommended for maximising women's chances of future fertility.

Fertility Success: Researchers Determine How Chemo Affects Female Fertility

"Chemotherapy induces menopause in some hormone-dependent cancers. It has a beneficial effect because it's withdrawing the stimulants for the cancer cells. Menopause is contributing to the cure," said Astsaturov. "It's still debated whether we should preserve menstrual function at all costs."

abstract: Should access to fertility treatment be determined by female body mass index? Human Reproduction

"Studies have shown that the direct costs per live birth are no greater for overweight and obese women..... Restricting fertility treatment on the grounds of BMI would cause stigmatization and lead to inequity, feelings of injustice and social tension as affluent women manage to bypass these draconian restrictions."