Fertility Q&A Ovarian Tissue Freezing

Fertility Q&A Ovarian Tissue Freezing:

An emerging method of fertility preservation offers hope for women with cancer.

By Karine Chung, MD, MSCE

If you are preparing to undergo cancer treatment, you may already be aware that cancer therapies—including chemotherapy and radiation—can cause infertility and premature menopause. If having children after completing your cancer treatment is important to you, you may have begun to consider options for fertility preservation. Because your chance of future successful pregnancies is best when fertility preservation procedures are performed before chemotherapy or radiation, the amount of time available to pursue these procedures is often limited and depends on when your cancer treatment is scheduled to start........

open access: Cancer, Fertility Preservation, and Future Pregnancy: A Comprehensive Review

Cancer, Fertility Preservation, and Future Pregnancy: A Comprehensive Review

Obstetrics and Gynecology International
Volume 2012 (2012), Article ID 953937, 11 pages
doi:10.1155/2012/953937 Review Article Cancer, Fertility Preservation, and Future Pregnancy: A Comprehensive Review

• Abstract
• Introduction
• Methods and Materials
• Results and Discussion
• Options for Fertility Preservation
• Additional Considerations
• Pregnancy after Cancer

Conclusions 

Given the relatively high incidence of cancer in reproductive age women and improvements in 5-year survival, an increasing number of women are presenting for discussion of fertility preservation and pregnancy after cancer treatment. The ASCO published recommendations in 2006 on fertility preservation in cancer patients. These guidelines state that oncologists should address the possibility of infertility with cancer patients and be prepared to discuss possible fertility preservation options or refer the patient to a reproductive specialist. Part of the difficulty in counseling patients regarding the risk of infertility and/or subsequent pregnancy complications is that the risks are dependent on several factors. These risks include the dose and duration of treatment, other risk factors for infertility, the age of the patient, and the patient’s baseline ovarian reserve at the time of initiation of treatment.

currently recruiting: Cryopreservation of Ovarian Tissue - Full Text View - ClinicalTrials.gov

Cryopreservation of Ovarian Tissue - Full Text View - ClinicalTrials.gov

This study is currently recruiting participants.

Verified March 2012 by Weill Medical College of Cornell University

First Received on February 16, 2012.   Last Updated on March 19, 2012   History of Changes

abstract: Pediatric and Young Adult Patients and Oncofertility.

Pediatric and Young Adult Patients and Oncofertility.:
Pediatric and Young Adult Patients and Oncofertility.

Abstract
OPINION STATEMENT:

With improving survival rates for pediatric and young adult cancer patients, considerations regarding the long-term effects of therapy have become more important. Cancer therapies are known to pose reproductive risks, though the effects may be unpredictable. All at-risk patients should have a discussion about potential treatment-related infertility before the onset of cancer therapy, and should be offered appropriate fertility preservation options. Embryo and sperm cryopreservation are considered standard therapy, though oocyte cryopreservation is gaining acceptance. Ovarian tissue cryopreservation, while still experimental, is showing great promise. It is the only option currently available to prepubertal girls. No fertility preservation options exist for prepubertal boys though some institutions may offer experimental testicular tissue cryopreservation.

JCO: Editorial - Ovarian Suppression for Prevention of Premature Menopause and Infertility: Empty Promise or Effective Therapy? (in Breast Cancer) see note/your comments?

Blogger's Note:  compared with other young cancer survivors??
                 ~~~~~~~~~~~~~

"Fertility and premature menopause are major concerns for young patients who are undergoing treatment for cancer. Young women with breast cancer face particular challenges when considering future fertility compared with other young cancer survivors.¹ The greatest concern is whether preservation of ovarian function and a subsequent pregnancy in a breast cancer survivor could increase the risk of recurrence, particularly in patients with hormone receptor–positive disease....."

See accompanying article on page 533

abstract: Malignant ovarian germ-cell tumours

Malignant ovarian germ-cell tumours account for about 5% of all ovarian malignancies and typically present in the teenage years. They are almost always unilateral and are exquisitely chemosensitive. As such, the surgical approach in young women with such tumours confined to a single ovary should aim to preserve fertility.....

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.

Uncertainty Over Use of GnRH Agonists in Breast Cancer (fertility preservation)

"One randomized trial is still ongoing — the Prevention of Early Menopause (POEMS), in women with hormone-receptor-negative breast cancer.

In view of the conflicting data, and while mature results from ongoing studies are awaited, the role of this treatment approach remains "uncertain," Dr. Partridge notes in her editorial.

Women...should not rely on GnRH agonist treatment.

"Given the current level of evidence, women who are interested in future fertility, and the providers who are assisting them in these often difficult decisions, should not rely on GnRH agonist treatment during chemotherapy for preservation of menstrual and ovarian function or fertility," she concludes."

abstract: Pregnancy after adolescent and adult cancer: A population-based matched cohort study (Norway)

"In summary, fertility-preserving attempts have succeeded in patients with ovarian or testicular cancer and in males with Hodgkin lymphoma. Male survivors initiated pregnancies in a higher degree than female survivors."

At 10 U.S. Centers, Cancer Doctors Freeze Babies' Ovaries to Preserve Fertility - TIME Healthland

abstract: Pregnancy after adolescent and adult cancer: A population-based matched cohort study

"In summary, fertility-preserving attempts have succeeded in patients with ovarian or testicular cancer and in males with Hodgkin lymphoma."

Multiple synchronous primary ovarian malignancies in a patient with a MLH-1 mutation: Impact on potential fertility preservation (MLH1 is one of the Lynch Syndrome genes) including commentary

"EOC associated with HNPCC syndrome differs compared to sporadic cases with mean age at diagnosis of 42.7"


(Note: Definition synchronous: occurring or existing at the same time)

  Abstract:

Introduction

While the majority of epithelial ovarian cancer (EOC) is due to sporadic mutations, approximately 10% of cases are secondary to hereditary germ line mutations: 85–90% of tumors are caused by BRCA1 and BRCA2 gene mutations while hereditary non-polyposis colorectal cancer (HNPCC), or Lynch syndrome, accounts for the remainder [1].

HNPCC patients may have synchronous primary tumors at the time of prophylactic or therapeutic surgery, involving the colon, ovary, uterus or a combination thereof. We present an unusual case of a patient with HNPCC syndrome and three primary ovarian neoplastic processes without coexisting colon or uterine malignancies, and underscore the importance of hysterectomy and bilateral salpingo-oophorectomy in cancer-associated mutation carriers from Lynch syndrome families........cont'd




Also: link to referenced article:
Cancer 

Fertility preservation in young women with epithelial ovarian cancer 
Volume 115, Issue 18, 15 September 2009, Pages 4118-4126  

METHODS: Women aged ≤50 years with stage IA or IC epithelial ovarian cancer who were registered in the Surveillance, Epidemiology, and End Results database were examined.......cont'd

Technique to Preserve Fertility in Young Women May Be Unsafe for Patients With Leukemia (AML/CML)-- press release

Note: study of 18 patients (AML/CML)

WASHINGTON, Aug. 13 /PRNewswire-USNewswire/ --

Although the use of ovarian tissue cryopreservation and transplantation has lead to 13 live births in women with lymphoma or solid tumors, this method of fertility preservation may be unsafe for patients with leukemia, according to a recent study published online in article: Blood, the journal of the American Society of Hematology "Reimplantation of cryopreserved ovarian tissue from patients with acute lymphoblastic leukemia is potentially unsafe". The method involves removing and freezing ovarian tissue before the patient undergoes aggressive chemotherapy and radiotherapy, and then reimplanting the tissue once the cancer has been brought under control. One major concern with leukemia patients is the risk that their frozen-thawed ovarian tissue might harbor malignant cells that could induce a recurrence of the disease after reimplantation.

"Our study provides clear evidence that cancer cells in women with acute and chronic leukemias can contaminate the ovaries," said Marie-Madeleine Dolmans, MD, professor at the Universite Catholique de Louvain in Brussels and lead author of the study. "If this tissue is reimplanted in these women when they're ready to have children, there's a good possibility that the cancer will come back." ...cont'd

"Moreover, chemotherapy before ovarian cryopreservation does not exclude malignant contamination. Finally, reimplantation of cryopreserved ovarian tissue from ALL and CML patients puts them at risk of disease recurrence."

Consistency in Insurance Coverage for Iatrogenic Conditions Resulting From Cancer Treatment Including Fertility Preservation -JCO