New Tool Guides Doctors To Save Cancer Patients' Fertility

Research in a new field called oncofertility has advanced the ability of doctors to preserve the reproductive health of women, men and children who are diagnosed with cancer. Yet, many oncologists aren't familiar with these new strategies to help their patients.

A leading oncofertility researcher and a breast surgical oncologist from the Northwestern University Feinberg School of Medicine have written a guide to help doctors navigate their patients through the new technologies to preserve their fertility and understand the fertility threats posed by cancer treatments. The guide, based on the latest research, offers strategies based on each kind of cancer, age and gender of the patient.

The article is published in the February 26 issue of the New England Journal of Medicine and is included in the NEJM Audio Summary.

"We hope that physicians who are not used to dealing with fertility threats associated with treatment can now talk confidently with their patients about their options," said article co-author Teresa Woodruff, chief of fertility preservation and the Thomas J. Watkins Professor of Obstetrics and Gynecology at the Feinberg School. "This is a new tool for them."

"Doctors are focused on saving a patient's life and are not used to thinking about preserving a patient's fertility and incorporating fertility preservation into her or his care," said lead author Jacqueline Jeruss, M.D., assistant professor of surgery at Feinberg. Jeruss also is a surgical oncologist at Northwestern Memorial's Prentice Women's Hospital and a basic science researcher at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University.

Younger patients in particular are not benefiting from fertility preservation options. A new national survey of pediatric oncologists showed that more than half of them are not using fertility preservation techniques that are available at most medical centers for their adolescent patients. The survey was conducted by Robert Brannigan, M.D., associate professor of urology at the Feinberg School and a physician at Northwestern Memorial Hospital.

"Adolescent oncology patients are at the same risk as adults to become permanently infertile as a result of their cancer or cancer treatment, but they are not getting what they need to save their fertility," Brannigan said.

When a young patient is diagnosed with cancer, doctors feel like it is a medical emergency, even when there may be time to consider fertility before treatment begins, Jeruss explained. "We aren't used to taking a step back to look at the big picture of patients' lives after they survive cancer," she said.

"Clinicians need to break through old practice patterns," Jeruss said. "In the past, if I saw a young woman with breast cancer, I would be focused on getting her into surgery and through chemotherapy and radiation. Now we have a better sense that with the improvements we've made in cancer management, many of our young patients with cancer are going on to survive and live healthy long lives. We need to do everything possible so patients can look forward to a life that looks as much like the life they had planned on before the day they were diagnosed."

The survival rate of children with cancer is nearly 80 percent in the United States. Approximately 10,700 children were diagnosed with cancer in 2008. In addition, there are 140,000 young adults (men and women younger than 45 years old) who face a cancer diagnosis each year.

Northwestern has led the emerging field of oncofertility and has provided a template of fertility preservation patient care to other medical centers. Woodruff developed and is principal investigator of the national Oncofertility Consortium, a National Institute of Health- funded network of doctors and scientists working to provide improved fertility preservation options for people diagnosed with cancer and other diseases.

At the Lurie Cancer Center, newly diagnosed men, women and adolescents work with a special Fertility Preservation Patient Navigator to figure out the best options to preserve their reproductive health before starting cancer therapy. The patient navigator then coordinates that plan with the patient's doctors.

Several fertility preservation techniques are under investigation at Northwestern. One is an entirely new way of growing and preserving a woman's immature eggs, or young follicles, so they can be fertilized and implanted into the uterus when she is ready to have children. Thus far, this technology has been used successfully in mice to produce live, healthy offspring.