There are fewer more tragic scenarios than cancer diagnosed in children and young adults. One aspect of this clinical scenario that we don’t often consider is future fertility. Chemotherapy attacks dividing cells and thus can attack the cells that divide to create eggs- the foundation of starting a pregnancy. Many women who undergo chemotherapy experience “ovarian failure” afterwards, meaning that they effectively go into menopause and their childbearing years are over.
The January 2015 Gray Journal published an exciting article that provides hope for young cancer patients. Dr. Oktay and co-authors from New York and Sao Paulo, Brazil, report on the success of ovarian preservation for cancer patients. Two 23-year-old women with blood cancers underwent surgery to remove ovarian tissue prior to starting chemotherapy and stem cell transplant. The surgeons removed one ovary and froze the ovarian tissue.
As often happens, both women experienced ovarian failure after chemotherapy. In days past, this could mean inability to achieve pregnancy using their own genetic material. However, none for these women. The surgeons took the frozen ovarian tissue and transplanted onto the patients’ remaining menopausal ovary. The women took estrogen supplements and baby aspirin to help the transplanted tissue to take root.
The next series of procedures were doubtlessly difficult and took almost a year. Seven years after the tissue was frozen for one patient and 12 years after the tissue was frozen for the other patient, the women desired pregnancy. The fertility doctors took over and used traditional in vitro fertilization techniques to stimulate the ovaries to produce eggs. After 7-8 cycles of IVF, the doctors were able to harvest eggs and create embryos in the petri dish. The doctors then transferred these petri dish embryos into the women’s wombs. One patient conceived after 4 transfers and the other conceived after the first transfer.
The result? Success! One pregnancy is ongoing and the other resulted in a health term baby girl. This article takes us into the future of medicine, using cutting edge technology, surgical, and medical techniques to enable previously impossible feats and giving hope to young cancer patients who desire future childbearing.