Download Slide 1

Paul C Magarelli, MD, Ph.D.
Francis “Cisco” Byrn, MD
UNM RE&I Team
Patient
Hopes
Society
Needs
Western
Medicine
East/CAM
Medicine
Practice
Promise
One
Medicine™
Healthy
Individual
Prosperous
Society
• How many of you have direct responsibility for a women’s
health care issue?
• How many of you have taken care of women with cancer?
• How many of you have asked women diagnosed with cancer
what their plans are for their future fertility?
• If Yes, Why did you?
• If No, Why not?
• Age
• Too sick
• Too young
• If you knew you had 5 more years to live would you think your
decisions regarding future fertility would be different?
Creating Families, Helping Patients, Healing society
Patien
t
Hopes
5/23/2017
Practi
ce
Promi
se
Societ
y
Needs
Western
Medicine
East/CA
M
Medicine
One
Healthy
Individual
Prosperous
Society
4
Overview
• Cancer epidemiology
• Effect of cancer therapy on fertility
• Male options
• Female options
• Children’s options
• Barriers to fertility preservation
• Fertility counseling
• Further information sources
2
1. Long term survival of many cancers continues to improve
2. Quality of life is rarely discussed related to creation families
1.
i.e., what are your plans for a children when this is “all over”
3. Techniques exist to save sperm (> 25 years), save eggs
(probably just as long), save embryos (> 20 years)
4. If you not ask the patient, couple, family, parents they will not
consider it in relationship to fertility preservation
5. Techniques exist now to help females preserve their fertility
without the use of gonadotropins and can be accomplished in
a 20 min procedure and completed in 8 days!
•
•
•
•
Cancer Patients
Chronic Disease
Toxic Treatments
Exposure
•
•
•
•
Military
Space
Job
Nucelar
Introduction
• Long-term survival rates for many cancers are continually
improving
– 5-year event-free survival rates approach 80% in most childhood
cancers, with only a 10% risk of death from recurrent tumor in
many cancers
– 5-year survival rate for adult patients aged between 20 and 49
years is above 70%
• With more successful cancer treatments come QOL
issues
– Focus of care should expand beyond just survival to include
long-term QOL issues
• Options for fertility preservation are available
QOL = quality of life.
1. Mertens AC et al. J Natl Cancer Inst. 2008;100:1368−1379; 2. Möller TR et al. J Clin Oncol. 2001;19:3173−3181; 3. Robertson et al. BMJ.
1994;309:162; National Cancer Institute. SEER Cancer Statistics Review: Fast Stats. http://seer.cancer.gov/faststats/selections.php#Output.
Accessed April 1, 2009.
3
US: Cancer Sites as Percentage of
New Cancer Cases in 2009
Females
Males
Other
Breast
Lung/bronchus
Colon/rectum
Uterus
NHL
Thyroid
Kidney
Ovary
NHL = non-Hodgkin’s lymphoma.
American Cancer Society. Cancer Facts and Figures 2009. www.cancer.org.
Other
Prostate
Lung/bronchus
Colon/rectum
Bladder
NHL
Kidney
Leukemia
Oral cavity
4
US: Cancer Sites as Percentage of New
Cancer Cases in 2009
Cancer in 25- to 29-Year-Olds by Primary Site
Urinary System
2%
Oral Cavity &
Pharynx
2%
Respiratory System
2%
Soft Tissue
2%
Bones & Joints
1%
Other
1%
Invasive Skin*
18%
Leukemia
4%
Digestive System
5%
Lymphomas
16%
CNS
5%
Breast Carcinoma
8%
Endocrine
System**
11%
Male Genital Tract
11%
Female
Genital Tract
12%
* 70% Melanoma
** 96% Thyroid
Bleyer A, O’Leary M, Barr R, Ries LAG (eds): Cancer Epidemiology in Older Adolescents and Young Adults 15 to 29 Years of Age, Including
SEER Incidence and Survival: 1975-2000. National Cancer Institute, NIH Pub. No. 06-5767. Bethesda, MD 2006.
5
US: All Cancer Incidence and Mortality*
Rate/100,000 population
600
500
400
Incidence
Mortality
300
200
100
0
1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005
Year
*Includes all cancer sites (invasive).
National Cancer Institute SEER Cancer Statistics Review 1975-2006. www.seer.cancer.gov.
6
US Trends in 5 Year Relative Survival
5 Year Relative Survival Rates (%)
100
90
Breast (female)
Colon
Kidney
Leukemia
Lung/bronchus
NHL
Ovary
Pancreas
Prostate
Uterine cervix
80
70
60
50
40
30
20
10
0
1975-1977
1984-1986
1996-2004
Year of diagnosis
American Cancer Society. Cancer Facts and Figures 2009. www.cancer.gov.
7
Increasing Importance of
Fertility Education1,2
• Increasing numbers of patients are interested in fertility preservation
– In addition to long-term survival of childhood cancer patients, the median
age of first pregnancy is increasing
• A higher proportion of patients are diagnosed prior to family completion
• Treatment and survival are still the primary focus
– Appropriate to consider QOL after treatment, including possibility of
becoming biologic parents
• Options and outcomes of fertility preservation for both prepubescent
and postpubescent patients are continually evolving
• Fertility issues in premenopausal women and men diagnosed with
cancer present important challenges and can have lasting negative
consequences if not discussed adequately
1. Duffy C et al. Cancer J. 2009;15:27−33; 2. Simon B et al. CA Cancer J Clin. 2005;55;211−228.
8
Cancer Treatment Is Highly
Gonadotoxic: Radiation Therapy
• Female: Depletion of primordial follicles has been
demonstrated to occur in dose-related fashion1-4
– TBI associated with >90% permanent gonadal failure in women5,
with a higher spontaneous abortion and preterm labor rate vs
radiation-free women (38% vs 12% and 62% vs 9%,
respectively)2-6
• Male: Degree and permanency of radiotherapy-induced
testicular damage depends on treatment field, total dose,
and fractionation schedule
– Single-dose delivery less toxic than fractionated regimens5
– TBI causes permanent gonadal failure in approximately 80%
of men5
TBI = total-body irradiation.
1. Gosden RG et al. Hum Reprod.1997;12:2483−2488; 2. Critchley H. Med Pediatr Oncol. 1999;33:9−14; 3. Critchley H et al. Hum Fertil.
2002;5:61−66; 4. Meirow D. Leuk Lymphoma. 1999;33:65−76; 5. Simon B et al. CA Cancer J Clin. 2005;55:211−228; 6. Sanders JE et al.
Blood. 1996;87:3045−3052.
9
Radiotherapy-induced Damage
to the Reproductive Tract1,2
Site
Rad
Rx
Effect
Males
Cranial/TBI
TBI/pelvic/testes
Endocrine axis disruption
Germinal epithelium
>1.2 Gy azoospermia
0.1-1.1 Gy oligospermia
Leydig cells
>20 Gy prepubertal
>30 Gy postpubertal
Females
Cranial/TBI
TBI/abdomen/pelvic
Endocrine axis disruption
Ovarian failure
Older >5 Gy
Younger >20 Gy
Uterine damage
Decreased volume
Decreased elasticity
Gy = Gray unit.
1. Simon B et al. CA Cancer J Clin. 2005;55:211−228; 2. Thomson AB et al. Best Pract Res Clin Endocrinol Metab. 2002;16:311−334.
10
Cancer Treatment Is Highly
Gonadotoxic: Chemotherapy
Chemo
Rx
• Female: Varies based on duration, dose, and type of chemotherapy
as well as patient age1
– Significant toxicity attributed to alkylating agents 2
– Increased risk of early menopause after treatment with alkylating agent
in women who resumed normal menses2
– Recovery of ovarian function is rare following regimens that include
busulphan and cyclophosphamide3
• Male: High doses of alkylating agents (ie, cyclophosphamide,
procarbazine, chlorambucil, and/or BCNU) result in azoospermia in
over 90% of men
– Small studies suggest that after therapy, sperm integrity is reestablished
to age-matched controls after time4,5
1. Meirow D. Mol Cell Endocrinol. 2000;169:123−131; 2. Byrne J et al. Am J Obstet Gynecol. 1992;166:788−793; 3. Socié G
et al. Blood. 2003;101:3373−3385; 4. Thomson AB et al. Lancet. 2002;360:361−367; 5. Chatterjee R et al. Hum Reprod.
2000;15:762−766.
11
Chemotherapy: Gonadotoxic Agents1,2,3
Taxanes
Oxaliplatin
Irinotecan
Monoclonal
antibodies
Tyrosine kinases
inhibitors
Methotrexate
5-Fluorouracil
Vincristine
Bleomycin
Actinomycin D
Cisplatin
Carboplatin
Doxorubicin
Cyclophosphamide
Chlorambucil
Melphalan
Busulphan
Dacarbazine
Procarbazine
Ifosfamide
Nitrogen mustard
Increasing Gonadotoxicity
Unknown
Low
High
Adapted from: 1. Lee SJ et al. J Clin Oncol. 2006;24:2917−2931; 2. Pentheroudakis G et al. Ann Oncol. 2008;19(suppl 2):ii108−ii109;
3. Sonmezer M et al. Hum Reprod Update. 2004;10:251−266.
12
Gonadal Dysfunction Rates Associated With
Common Chemotherapeutic Regimens
Fertility in Adult Men Following Treatment of Different Maligna ncies2
Hypergonadotropic
hypogonadism
reported in 19% of
male survivors
following hematologic
diseases1
Diagnosis and Treatment
Hodgkin’s lymphoma
MVPP
MOPP
ChlVPP/EVA hybrid
COPP
ABVD
NHL
CHOP
VAPEC-B
VACOP-B
MACOP-B
VEEP
Bone marrow transplant for a variety
of malignancies
Cyclophosphamide alone
Busulphan and cyclophosphamide
CBV
High-dose melphalan
BEAM
Testicular cancer
Cisplatin/carboplatin-based therapy
Fertility Posttreatment
Azoospermia in >90%
Azoospermia in >90%
Azoospermia in >90%
Azoospermia in >90%
Temporary azoospermia with normal sperm
count in all at 18 months
Permanent azoospermia in ≈ 30%
Normospermia in >95%
Normospermia in >95%
Normospermia in >95%
Normospermia in >95%
FSH raised in 40%
FSH raised in 80%
FSH raised in >95%
FSH raised in >95%
FSH raised in >95%
Normospermia in 50% at 2 years and 80%
at 5 years
1. Somali M et al. Gynecol Endocrinol. 2005;21:18−26; 2. Howell SJ et al. J Natl Cancer Inst Monogr. 2005;(34):12−17.
13
7,000,000 eggs
Before delivery
2,000,000 eggs
Newborn
600,000/mo
400,000 eggs
at Puberty
10,000/mo
We lose
We only have
400 ovulations
in our lives!
1000 eggs
per month
400,000 eggs
at Puberty
13 yo
of each
menstrual
cycle, whether
you ovulate or
not or even if
you are
pregnant or on
birth control
pills!!
Zero (0) eggs
at Menopause
50 yo
Gonadal Dysfunction Rates Associated With
Common Chemotherapeutic Regimens
Fertility in Women Following Chemotherapy for Breast Cancer2
Hypergonadotropic
hypogonadism
reported in 97% of
female survivors
following hematologic
diseases1
Chemotherapy
Regimen
CMF
CMF
CMF
FEC
CMF
FEC
ACD
FAC
AC-T/D
AC-T/D + tamoxifen
ACD
FAC
FEC
AC
ACT
CMF
FAC
FACT
ACD
AC
AC + T/D
Duration of
Treatment
(months)
1
6
3 to 24
6
6
6
6
6
6
6
FollowFollow-up to
Definite
Amenorrhea
(months)
9
12
NA
12
33
12
6
NA
4
4
6
8
6
6
6
4
4+3
120
36
12
1. Somali M et al. Gynecol Endocrinol. 2005;21:18−26; 2. Maltaris T et al. Breast Cancer Res. 2008;10:206−216.
Rate of Amenorrhea
Percentage Age (years)
14/34
<40/>40
33/81
<40/>40
40/76
<40/>40
42.6
55.6
64.6
51.4
13
17
61.7
52.4
64
53
42
82
NA
NA
45
44/81
61/85
<40/>40
<40/>40
14
Premature Ovarian Failure
in Cancer Patients
POF
Chemotherapy1
Radiation2
Oocyte population after irradiation
Probability of Early Menopause
Difference in oocyte population after treatment
Faddy-Gosden solution for early menopause
Translation of menopause from 51 to 13 years menopause
Faddy-Gosden model assuming no treatment
106
None
HormOnly
ChemOnly
Both
0.8
0.6
0.4
0.2
None
0
Oocyte population (log 10)
Estimated probability
1.0
105
Oocyte
population at treatment
age < 10.5 years
Oocyte
population
at birth
Surviving percentage is
(oocyte population at
treatment age) × 100
Untreated
menopause
at 51 years
104
Menopause at 13
years for patient
103
Oocyte
population
after irradiation
102
25
30
35
40
45
50
55
0
10
20
Age at diagnosis (years)
1. Goodwin PJ et al. J Clin Oncol. 1999;17:2365−2370; 2. Wallace WHB et al. Lancet Oncol. 2005;6:209−218.
30
40
50
60
Age (years)
15
Loss of Ovarian Function as an Adverse
Event to Cancer Therapy1
• Fore-knowledge of potential treatment-related
ovarian failure may help a physician to better
counsel a patient regarding the importance and
timing of fertility preservation.
• It is also important to note that the most recent
version of the Common Terminology Criteria for
Adverse Events (CTCAEv3) proposed by the
National Cancer Institute does not incorporate the
effects of cancer therapy on ovarian function.
– This may be an important “adverse event” to discuss
with your patients, and what fertility preservation
options may be appropriate for her.
1. Stroud JS et al. Fertil Steril 2009;92:417−427.
16
Measureable Endpoints for the Effects
of Cancer Therapy on the Ovaries1,2
Grade 1
Grade 2
Grade 3
Grade 4
Subjective
Hot flashes
Occasional
Intermittent
Persistent
Dysmenorrhea
Occasional
Intermittent
Persistent
Oligomenorrhea
Amenorrhea
Menstruation
Objective
Ovulation
Anovulation in
premenopausal women
Involuntary infertility
Infertility
Osteoporosis
Radiographic evidence Fracture
Management
Dysmenorrhea,
Dysmenorrhea,
hot flashes
Hormone replacement
Hormone replacement
Hormone replacement
Menstruation
Hormone replacement
Hormone replacement
Hormone replacement
Osteoporosis
Hormone replacment,
replacment,
calcium supplements
Hormone replacement, Hormone replacement,
calcium supplements
calcium supplements
Analytic
FSH/LH/estradiol
FSH/LH/estradiol
Assessment of
hormonal production
Bone densitometry
Quantify bone density
1. Stroud JS et al. Fertil Steril 2009;92:417−427; 2. Grigsby PW et al Intern J Rad Oncol Biol Phys 1995;31:1281−99.
17
Fertility Preservation Options1
Group
Method
Cryopreservation
Treatment
Recipient
Concerns
Patient or
gestational
surrogate
Delay in
cancer
treatment
Hormone
injections
Hormone
stimulation
Hormone
cycle
Women
Postpubertal girls
Hormone
cycle
2-3 weeks
Laparoscopic
oophorectomy
Postpubertal
girls
ET
Availability
of appropriate
sperm donor
2-3 weeks
Hormone
stimulation
Women
Zygote
or embryo
Mature oocyte
Cumulus–
Cumulus–oocyte
complexes
Ovarian
cortical strips
Ovarian
transplantation
Patient
In vitro follicle
maturation and
IVFor ICSI
with ET
Patient or
gestational
surrogate
ICSI with
ET
Partner
StemStem-cell
repopulation
Patient
Potential
reintroduction
of cancer cells
Experimental
Prepubertal
girls
Ejaculation
Mature sperm
extraction
Testis
biopsy
Men
Sperm
Testis
Experimental
Postpubertal boys
ET = embryo transfer; IVF = in vitro fertilization; ICSI = intracytoplasmic sperm injection.
1. Jeruss JS et al. N Engl J Med. 2009;360:902−911.
18
• In Vitro Maturation of Oocytes
• No need for hormone stimulation of ovaries
• No need to “time” retrieval of eggs, can be luteal phase
• Results are comparable to IVF status of 5 years ago
• 30% take home baby rates
• (todays IVF take home baby rates for < 35 yo are about
60%)
Fertility Preservation Options1
Group
Method
Cryopreservation
Treatment
Recipient
Concerns
Zygote
or embryo
ET
Patient or
gestational
surrogate
Delay in
cancer
treatment
Hormone
injections
Hormone
stimulation
Hormone
cycle
Women
Postpubertal girls
Hormone
cycle
2-3 weeks
Laparoscopic
oophorectomy
Women
Postpubertal
girls
Availability
of appropriate
sperm donor
2-3 weeks
Hormone
stimulation
Mature oocyte
Cumulus–
Cumulus–oocyte
complexes
Ovarian
cortical strips
Ovarian
transplantation
Patient
In vitro follicle
maturation and
IVFor ICSI
with ET
Patient or
gestational
surrogate
ICSI with
ET
Partner
StemStem-cell
repopulation
Patient
Potential
reintroduction
of cancer cells
Experimental
Prepubertal
girls
Ejaculation
Mature sperm
extraction
Testis
biopsy
Men
Sperm
Testis
Experimental
Postpubertal boys
ET = embryo transfer; IVF = in vitro fertilization; ICSI = intracytoplasmic sperm injection.
1. Jeruss JS et al. N Engl J Med. 2009;360:902−911.
18
Sperm Banking1,2
• Sperm is cryopreserved after masturbation
• Large cohort studies in men with cancer
• Other methods of sperm collection
– Electroejaculation
– Testicular aspiration or extraction
– Postmasturbation urine
• Can be used after spermarche (13-14 years)
– Age does not alter sperm quality
• Outpatient procedure
1. Lee SJ et al. J Clin Oncol. 2006;24:2917−2931; 2. Simon B et al. CA Cancer J Clin. 2005;55:211−228.
19
Testicular Freezing
•
Experimental option for prepubertal boys who
cannot produce sperm1,2
•
Testicular tissue or germ cells are frozen to be
re-implanted after cancer treatment1
– Store spermatogonia, Sertoli cells, and neighboring
cells as undamaged integrated tissue
•
Has been successfully used in research animals
– Human testicular tissue and spermatogonia have
been shown to survive and proliferate after
cryopreservation and long-term transplantation2
• Complete regeneration of spermatogenesis has
not yet been demonstrated 2
•
Integrity of tissue has been investigated, and no clear
structural changes have been observed in fresh, fresh
cultured, and cryopreserved tissue3
SG = spermatogonia
1. Lee SJ et al. J Clin Oncol. 2006;24:2917−2931; 2. Wyns C et al. Hum Reprod. 2008;23:2402−2414; 3. Keros V et al. Hum Reprod.
2007;22:1384−1395.
20
Fertility Preservation Options in
Women: Parameters to Consider1
• Age
• Type of treatment
• Diagnosis
• Partner status
• Time available
• Potential that cancer has metastasized
to the ovaries
1. Lee SJ et al. J Clin Oncol. 2006;24:2917−2931.
21
Freezing: Embryos1,2
• Following ovarian stimulation and IVF,
embryos are frozen for later
transplantation
• Most effective method for fertility
preservation
• Stimulation protocol can require 4-6
weeks and result in a delay in cancer
treatment
• Requires 10-14 days of ovarian
stimulation
• Requires partner or donor sperm
• Not an option for prepubertal girls
1. Kim SS. Fertil Steril. 2006;85:1−11; 2. Morice P et al. Nat Clin Pract Endocrinol Metab. 2007;3:819−826.
22
Freezing: Oocytes
•
Experimental method in women who do not
have a sperm donor or who cannot freeze
embryos1
•
Following ovarian stimulation, oocytes are
retrieved and frozen for later fertilization
– Alternatively, immature oocytes can be
collected, matured in vitro, and frozen2
•
Live births have been reported but are limited
to small case studies3
– (~2% per thawed oocyte by meta-analysis)
•
New technologies (vitrification) are improving:
– Oocyte survival after thawing (>80%) 4,5
– Birth rates (5% per thawed oocyte)4
– Clinical pregnancy rates (75-80% per thawed
oocyte)4,5
Image courtesy of David Hill, PhD.
Copyright, NV Tech Inc.
McGill
81% survival post thaw
76% fertilization rates
45% clinical pregnancy rates
40% live birth dates
1. Gook DA et al. Hum Reprod Update. 2007;13:591−605; 2. Chian R et al. Fertil Steril. 2009;91:2391−2398; 3. Oktay K et al. Fertil Steril. 2006;86:70−80; 4.
Kim C et al. Fertil Steril. 2009;ePub Ahead of Print; 5. Nagy Z et al. Fertil Steril. 2009;92:520−526.
23
Freezing: Ovarian Tissue
•
Experimental option for prepubertal girls or for
women who need immediate chemotherapy 1
•
Entails freezing of ovarian cortical tissue for
transplantation after cancer therapy1−3
Ovarian tissue graft
– Transplantation may be orthotopic (pelvic) or
heterotopic (forearm or abdominal wall)
– Initial ischemia following transplantation can result
in loss of follicles
• Transplantation of whole ovary may reduce ischemia
and preserve follicle number
Isolated follicles
– Successful fertilization and pregnancy after oocyte
collection in animal transplant models
– Currently few live births
•
Risk of transplantation of tumor cells in women
who have risk of ovarian metastasis3
1. Donnez J et al. Hum Reprod Update. 2006;12:519−535; 2. Kim SS. Fertil Steril. 2006;85:1-11; 3.
von Wolff M et al. Eur J Cancer. 2009;45:1547−1553.
24
• From Lab to Standard of Care
• In Vitro Maturation
• Obtaining immature oocytes and maturing, fertilizing, then implanting
these embryos into cancer patients
• Historic yield per ASRM meta-analysis review – 1.9 to 2% live birth
• McGill data, 2010, 40% take home baby rates
• Pro’s & Cons
• Pro
• Any time during the cycle
• No excess Estradiol levels since no gonadotropins used
• No statistical increase in congenital anomalies noted
• Con
• Limited data
• Slightly lower outcomes, but not statistically different in fertilization, implantation,
ongoing pregnancy and live births
Ovarian Transposition
(Oophoropexy)1,2
• For women undergoing radiation
therapy, ovaries are surgically
repositioned away from radiation field
• Enables immediate initiation of
radiation therapy
• May need to reposition the ovaries
or undergo IVF in order to conceive
• Risk of damage to blood supply
• Limited to young cancer patients
treated with radiation only
Image courtesy of Pediatric Surgery Residency
Program of the Warren Alpert Medical School of
Brown University Image Bank 3
1. Marhhom E et al. Obstet Gynecol Surv. 2007;62:58−72; 2. Lee SJ et al. J Clin Oncol. 2006;24:2917-2931; 3. Warren Alpert Medical School of
Brown University. http://bms.brown.edu/pedisurg/Brown/IBImages/Ovary/LaparoscopicOophoropexy.html. Accessed April 7, 2009.
25
Other Options
26
Third Party Reproduction
• Use of eggs, sperm, embryos, or a uterus that are
donated by a third person (gamete donor or
surrogate) to an infertile couple (recipient) to
enable them to become parents
• Gamete donors can be known (directed) or
anonymous
• Surrogacy laws vary from country to country
27
Adoption (Male and Female)1
• Can be costly ($5000-$40,000)
• Factors affecting cost
–
–
–
–
–
State regulations
Agency (public or private) services provided
Travel expenses
Birth mother expenses
Other factors
• Cancer history can be prohibitive
– May need to wait 5 years
– Letter from oncologist
1. Adoption.com. http://costs.adoption.com. Accessed April 7, 2009.
28
Burdens on Cancer Patients
• Time is short!
• Insurance coverage may vary according by state
– Cancer
– Fertility treatment
• Costs associated with treatment
– Variable treatment duration
– Employment reduction or loss
29
Fertility Counseling
• Fertility counseling is not routine1
• Reasons for lack of counseling2
–
–
–
–
Lack of knowledge about options and resources
Time
Inability to delay treatment to make use of the options
Number of children the patient already has
• Role of the oncology nurse3
– Nurses may be in an ideal position to discuss fertility
preservation
– Nurses believe that this is part of their role
1. Mancini J et al. Fertil Steril. 2008;90:1616−1625; 2. Quinn GP et al. J Cancer Surviv. 2007;1:146−155; 3. King L et al. Clin J Oncol
Nurs. 2008;12:467−476.
30
Resources
The Lance Armstrong Foundation
www.livestrong.org
American Society of Clinical Oncology
Guidelines for Fertility Preservation
www.asco.org
American Society for Reproductive
Medicine
www.asrm.org
The Oncofertility Consortium
www.myoncofertility.org
31
Conclusions
• Options exist for both young male and female patients
with cancer
• Established male option is sperm banking; testicular
freezing is experimental
• Established female options include embryo freezing and
ovarian transposition; experimental methods include
oocyte and ovarian tissue freezing
• Counseling patients on their options for fertility
preservation should be an integral part of an oncologist’s
treatment plan
32
• Pediatrics
• Male
• Testicular biopsy & freeze
• Female
• Ovarian biopsy & freeze
• Reproductive Age Females & Males: based on goals
• What you should expect from the RE&I’s when you contact us
regarding oncology patients
• Meet the patients
• Discuss options for gamete versus embryo preservation, with some
discussion of the impact of oncologic procedures on future fertility
• Based on timing, either traditional IVF versus IVM management
• Coordination with Oncology team for care plan
Patient
Hopes
Society
Needs
Western
Medicine
East/CAM
Medicine
Practice
Promise
One Medicine™
Healthy
Individual
Prosperous
Society
Contact: 505-272-3886
Drs. Byrn and Magarelli