FERTILITY PRESERVATION News
We here want to encourage colleagues in all pediatric and adult medical specialties to carefully consider the concept of medical fertility preservation whenever facing treatments that may endanger a young woman’s (or man’s) future fertility. Vitaly A. Kushnir, MD, Director of CHR’s Fertility Preservation Center (FPC), and other CHR physicians are available for emergency consultations 24 hours a day, 365 days a year, by calling (212) 994 4400. Just call CHR’s whenever an emergency arises (after regular hours you will be referred to an answering service).
In this issue of Fertility Preservation News we focus on newly reported successes of fertility restoration after cancer treatment.
Beating Cancer Then Regaining Fertility
As cancer survival rates rise, fertility preservation discussions have rightly become commonplace following a cancer diagnoses. Fertility treatment such as egg freezing can take several weeks or longer, however, and aggressive cancer treatment sometimes cannot be delayed. In these cases, or if the patient is pre-pubescent, removing and freezing some or all of the ovary is an option. The tissue can be thawed and re-implanted, restoring fertility after cancer treatment.
A 27-year-old Congolese woman in Belgium recently gave birth to what is believed to be the first-ever child from a re-implanted ovary harvested and frozen during childhood. Years earlier, doctors had removed and froze her right ovary and some ovarian tissue when the then-premenstrual 13-year-old was fighting severe sickle-cell anemia. After chemotherapy and a bone marrow transplant she was disease free, but infertile.
Ten years later she wanted a child, so her doctors thawed some of the frozen ovarian tissue and grafted it onto her failed left ovary and elsewhere in her body. Within five months the tissue grew follicles with maturing eggs and she started a normal menstrual cycle. Two years later she became pregnant with no outside medical intervention. Her baby boy was born in July 2012, 6 pounds, 14 ounces.
The success, reported by Dr. Isabelle Demeestere et al1, represents an important, although expected, step in fertility restoration.
When an ovary can’t be saved
If, however, physicians are concerned re-implanting the ovarian tissue could retrigger the same cancer eradicated by their treatment, the risk to the patient’s health is too high. It is in this dire scenario that new, exciting work is being done.
When the removed ovary tissue cannot be reintroduced to the body, researchers are now removing immature eggs from that specimen and aging them in a laboratory setting in a process called in vitro maturation (IVM). These eggs—or embryos, if fertilized—can then be frozen for future use by the cancer survivor. Astonishingly, there is even evidence to suggest this process could work for very young children – although with a lower success rate than eggs from a mature ovary.
The breakthrough in this field happened in 2013 when doctors in Singapore treated a woman with ovarian cancer. The scientists retrieved oocytes from the cancerous ovary, matured them in vitro, and fertilized them with her husband’s sperm, resulting in three high-grade embryos. These were then frozen. The woman underwent two surgeries to treat her cancer. Fourteen months later, after extensive discussions with her oncologist and fertility doctors, she requested her frozen embryos be transferred. “Two embryos were thawed and replaced in an artificial frozen-embryo transfer cycle after three cycles of combined oral contraceptive pill treatment. This produced a normal healthy singleton pregnancy resulting in the live birth of a healthy baby boy at 2.58kg,” wrote her doctors2.
- Isabelle Demeestere, Philippe Simon, Laurence Dedeken, Federica Moffa, Sophie Tsépélidis, Cecile Brachet, Anne Delbaere, Fabienne Devreker, Alina Ferster. Live birth after autograft of ovarian tissue cryopreserved during childhood. Human Reproduction Hum. Reprod.(2015)doi: 10.1093/humrep/dev128
- E.B. Prasath, M.L.H. Chan, W.H.W. Wong, C.J.W. Lim, M.D. Tharmalingam, M. Hendricks, S.F. Loh, Y.N. Chia. First pregnancy and live birth resulting from cryopreserved embryos obtained fromin vitro matured oocytes after oophorectomy in an ovarian cancer patient. Human Reproduction. Hum. Reprod. (2013)doi: 10.1093/humrep/det420
Fighting for every egg and embryo