For Women with Cancer, the Fertility Preservation Pipeline Is Clogged

Here's a situation that illustrates how fantastic medical advances don't always translate to patients benefiting in the clinic. For that to happen, the science needs to be carried along a pipeline of practitioner communication, all the way to the patient.

Cancer patients' fertility is in the hands
of cooperating physicians. 

More women are surviving cancer. We know that some of the cancer treatments will leave them less fertile or even completely sterile. Fortunately, the assisted reproductive technology exists to help young women preserve their fertility for later use, post-cancer. But a new study in the journal Cancer says very few of these women take the steps to save their eggs or embryos before infertility-causing cancer treatment.

Of the 1,041 women sampled from the California Cancer Registry, ages 18 to 40 at time of diagnosis between the years 1991 and 2007, and who participated in the survey, only 4 percent underwent fertility preservation techniques.

One of the study's authors, Dr. Mitchell Rosen of California, cites a couple of reasons. One is cost. Another is the limited amount of related counseling that oncologists are providing to these frightened patients.

The good news is that more cancer doctors are informing their patients of the connections between cancer treatment and future infertility, partly due to guidelines instituted by the American Society of Clinical Oncology back in 2006. But just what constitutes adequate information is in question.

According to Rosen in this Huffington Post article, an oncologist may refer vaguely to the problem ('The treatment might affect your fertility, but let's figure out how we're going to go ahead and save your life') and "That brief sentence might be considered counseling..."

Another issue this study brings to light: it appears not every woman is equally informed, based on demographics like age, race, and even educational level. The article says:

"Those who had gone to college were 20 percent more likely to be counseled than those who had not.
Women who were childless, younger, white and heterosexual were also more likely to be told about the possible effects of cancer treatments on their ability to conceive."

In 2008, Houston Fertility Center published a website called BabyLater.com to inform the public that we offer a number of techniques for deferring conception by way of preserving fertility. The purpose of our website and my related outreach activities is to educate not only patients, but the abundance of professionals in the cancer care field here in Houston.

This Huffington Post article says a panel of recommendation experts is revising guidelines now, but they won't be made public for another year or more. The article also quotes Dr. Kutluk Oktay, co-chair of that expert panel, commenting on the current state of that crucial information pipeline:  "On the cancer side, there's no official training for this."

Physicians on the front line of cancer treatment are holding the cards in terms of letting women know that they have choices, that they can save their ability to have children in the future. I will continue to do what I can to spread the good news, that not only is there very often life after cancer, but parenthood, too.

~ Dr. Sonja Kristiansen M.D.

“Racial, Socioeconomic, and Demographic Disparities in Access to Fertility Preservation in Young Women Diagnosed With Cancer.” Joseph M. Letourneau, James F. Smith, Erin E. Ebbel, Amaranta Craig, Patricia P. Katz, Marcelle I. Cedars, and Mitchell P. Rosen. CANCER; Published Online: March 26, 2012 (DOI: 10.1002/cncr.26649).

Cancer & Infertility: The Good Part of the Bad News

We've known for a long time now that cancer treatment can save lives but also render survivors infertile, even completely sterile. Young people who were surviving cancer more often found their new lives had a huge gap: little to no chance of being a parent in the future.

Spurred by organizations like Fertile Hope and the Young Survivors Coalition, researchers began focusing on fertility preservation techniques and their usefulness for this population. We've come a long way with what we can offer both men and women who want a chance at family-building after they're cancer-free. (At Houston Fertility Center, we offer a number of these techniques and even have a site devoted just to deferring conception by way of preserving fertility.)

Now, it appears as though the numbers of women with infertility resulting from cancer treatment is bigger than we thought. A large survey study by the University of California, San Francisco (UCSF) has concluded that our previous understanding may have given women "unrealistically low assessments of their risks" for infertility.

Some of the salient points of this study:

*Acute ovarian failure (no longer having a menstrual period after chemotherapy) increases significantly with age at cancer diagnosis.

*For women who did not experience loss of menses, incidence of infertility increased significantly with age.

*The younger the woman was when diagnosed with cancer, the higher her chances of early menopause.

Learning that the impact of chemotherapy on fertility is greater than we assumed -- that's the bad news.

The good news? That we now have that knowledge and can let women and their oncologists know that the need for fertility preservation is more prevalent than we used to think.

Fertility Treatment for Cancer Patients Is Reality. Even If They Don't Know It Yet.

Houston is a major destination for people battling cancer. The city's medical center is renowned for providing the most advanced cancer care available, and patients come from around the world to access life-saving science and techniques. Besides the facilities in the centrally-located Texas Medical Center, there are also cancer treatment centers in outlying areas around Harris County where patients are receiving the benefits of cutting edge research put into clinical practice.

More cancer patients are surviving and going on to live healthy, happy lives. But many forms of cancer treatment result in infertility. Fortunately, the technology exists now to take steps to preserving a person's fertility for the future. Freezing embryos and freezing eggs top the list of techniques proving successful. And for patients who have types of cancer that are transmitted genetically, the technology is available to screen embryos for the related genes.

I've networked for several years now with organizations that assist cancer patients, groups like Livestrong's Fertile Hope program, the Young Survivors Coalition, and the Susan G. Koman Foundation. Speaking to groups about fertility preservation is always eye-opening for them and for me. I continue to hear the same sense of surprise and sometimes regret from participants who wish they had known before undergoing cancer treatment. I wish they had known, too.

If you know someone who's struggling with cancer, let them know that infertility doesn't have to be part of the result. Help me and other reproductive endocrinologists make fertility treatment available to cancer patients, by spreading the word about the hopeful possibilities.

Also see:

Women Want Working Options for Motherhood
On Lindsay Nohr Beck's presentation at ASRM 2009.


Fertility Preservation and Oncology
My thoughts about Jane Brody's column on how oncology is still behind the curve in addressing their patients' future fertility needs.

When It Comes to Cancer, We're All On the Same Team

Did you know that many women who survive cancer are unable to have children later? That's because life-saving cancer treatments can result in complete sterility. Fortunately, cancer survivors are increasingly speaking out about what they want out of life after illness. I've been privileged to offer these women fertility-sparing options so they can choose life both ways.

This Saturday, October 2nd, one of my sons is running in the 2010 Komen Houston Race for the Cure. A couple of years ago, I spoke to a gathering of women who form the Education Committee of the Susan G. Komen for the Cure Houston, the nation's premiere advocacy and research organization. The questions from this particularly well-informed audience led me to realize that more general public education is needed.

Cancer survival increases steadily. Fertility treatments to allow survivors to become parents is available. What is still slowly developing is a pipeline of patient information and referral. Too many women find themselves on the infertile side of cancer treatment asking why they hadn't heard of fertility preservation before it was too late.

The Komen Foundation has funded great strides in research to help women survive cancer and go on to have fulfilled lives. I urge you to do what you can to continue supporting their mission. And spread the word yourself to friends affected by cancer: fertility preservation is not experimental science. It is medical care that is currently available.

European Women Happy to Freeze Eggs for Future

According to two studies presented at the annual meeting of the European Society of Human Reproduction & Embryology (ESHRE), European women are embracing the idea of egg freezing as a means of having more reproductive control over their lives.

A small Belgian study of women average age 38 years found that half of them planned to freeze their eggs to lessen the pressure they feel to find the best parenting partner. Most foresaw using their eggs for conception after age 40.

A larger study in the UK saw eight in 10 medical students would be willing to freeze their eggs so that career growth could continue to take a front seat.

Women in the U.S. are also warming up to the idea of using assisted reproductive technology even when infertility isn't an issue in their life. Advances in the technology have made egg freezing with IVF more affordable and even covered by some women's insurance plans.

http://www.bioedge.org/index.php/bioethics/bioethics_article/9085/

Another Step Forward Toward Fertility Preservation

A drug used to treat ovarian cancer (cisplatin) promotes egg cell death by way of a particular enzyme. The good news: a drug used to treat a different (but related) disease, chronic myeloid leukemia (CML), protects egg cells from cisplatin's killing effects.

Researchers in Italy have published their interesting conclusions in the online edition of Nature Medicine (see a HealthDay News report on the Medline website.)

So far, these are initial studies performed with mice, but the call by cancer patient advocates for such research is loud enough that follow-ups shouldn't be far behind.

TV Reflecting Hopeful New Reality

Especially after hearing from my staff (who atttended the annual Young Survivors Conference in Dallas last month ) about the mix of hope and anguish that young women with cancer express about their future motherhood, it was reassuring to see the very popular TV show, Grey's Anatomy, work the forethought of fertility preservation into a current, compelling storyline.

A young woman must undergo intense and immediate treatments for invasive cancer. Her colleagues and friends think ahead for her and automatically include the OB team in her treatment plan.

In this related scene, the cancer patient's boyfriend reveals the understandable and expected emotions involved as people struggle to muster hope amid fears:

Upcoming Seminar on Fertility Preservation

On Monday, January 19th, I will be speaking to a public audience on the topic of egg freezing for fertility preservation.

Hosted by the Young Survivors Coalition, a non-profit breast cancer support and advocacy group, my primary focus will be on the potential for women who are newly diagnosed with cancer to protect their eggs from sterilizing effects of chemo or radiation therapy.

Our primary goal is to continue getting the word out there, so that pre-cancer treatment fertility preservation considerations are standard of care in the oncology field. I welcome attendance at these presentations by patients and professionals alike.

I like to present in a casual Q&A style, so please feel free to come with your questions.

The location will be one of the facilities of The Rose, an organization committed to helping all women be adequately screened for breast cancer.

When: Monday, Jan 19th, 6:30 PM
Where: The Rose, 12700 North Featherwood, Suite 260 Houston, Texas 77034


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This presentation is made possible in part by Fertile Hope and Organon, a part of Schering-Plough Corporation.

Article in Houston B.A.B.Y. Magazine

[Edited 11/26/08: We now have a copy of the article in PDF format on our BabyLater.com site. Read it here...]

I'm featured in an article for Houston B.A.B.Y. Magazine, a publication of Houston Family Magazine. The October issue is available in digital format here (click on the cute baby face cover), and you can find print issues at Krogers, and in OB/Gyn and pediatrician offices.

The article is called "From Cancer to Parenthood: Reproductive Expert Helps Survivors Create New Life" and includes a pretty interesting photo of Dr. Stoddart in the lab.

I'm glad the feature highlights my efforts at bridging the gaps between oncologists and reproductive specialists. Patients are the prospective losers if the facts about fertility preservation aren't immediately available at that very first discussion about cancer treatment. Making those physician-to-physician connections well in advance of patient need will be the key to enabling more survivors to become parents later.

Please feel free to share this article with your physicians and friends.

For easy sharing by email and for printing, I recommend this: find the article on page 16, click on the article title words "From Cancer to Parenthood" to display the article in easy-print format. From there, you also have options to post the article on your Facebook, MySpace, and other favorites. (Technology is great, but tricky at times...)

More Local News Coverage of Egg Freezing for Fertility Preservation

I received a last-minute request earlier this week from Elizabeth Lee, reporter for 39 News. Since I had two surgeries and an IVF to perform that afternoon, she and her video team made their way to the lab in central Houston for some interesting cryo shots after catching me at our Sugar Land office.

We talked about egg freezing and using the technique to preserve future fertility for women diagnosed with cancer, as well as for young healthy women who are worried they may not find "Mr. Right" before their egg cells age.

You can see the video on the 39 News website.

Another Great Day Houston

Following last July's show, I was asked to visit Great Day Houston again to talk more about fertility-sparing treatments for women who wish to delay conception.

Tune in to Great Day Houston with Deborah Duncan - Tuesday, October 21
at 9 AM Central on KHOU-Channel 11. Or watch online by clicking the Live Video link from http://www.greatdayhouston.com/ during airtime.

The techniques to retrieve and freeze egg cells for future conception are primarily offered to women who have just been diagnosed with cancer. We're working on collaborative relationships with cancer specialists and other professionals who can quickly refer patients for fertility preservation before they undergo sterility-causing cancer treatment.

As long as patients are willing to educate themselves and be fully aware of the process involved, women without cancer can also utilize fertility preservation technology to have a baby later.

Learn more about fertility preservation (for women and men) at http://babylater.com.

[Edited 10-31-08 to add link to view video here...]

Spreading the Word About Fertility Preservation

Last week, I had the pleasure of meeting with and speaking to the Educational Committee of the local Susan G. Komen Foundation group.

What a thriving organization! Just a few days after their annual Race for the Cure®, with participants this year numbering over 26 thousand, the women who lead Komen's educational charge gathered again in an office crowded with boxes of materials and mementos.

Lorianne Classen, a Health Education Specialist with M.D. Anderson Cancer Center and Komen volunteer, remarked that the meeting was particularly well-attended that evening, likely because of interest in our topic: fertility preservation.

Judging from the many raised hands with questions, including several from survivors and their loved ones, I'd say that interest in the concepts of preserving fertility for use after surviving cancer was indeed very high. Good questions. Poignant situations.

I left feeling very positive about sharing the realities of how women and men can take action to preserve their fertility before engaging in life-saving cancer treatment. I also came away seeing the need for education *now* is possibly greater than I thought.

As I emphasized to the Komen Education Committee, timing is crucial in this matter. I'll be continuing my pursuit of pre-need connections among oncology specialists and their patients -- through http://babylater.com -- so that the information about real hope for having a family isn't only wistful hindsight for cancer survivors.

For more information, visit the Houston affiliate of the Susan G. Komen for the Cure.