NCI Cancer Bulletin: A Trusted Source for Cancer Research NewsNCI Cancer Bulletin: A Trusted Source for Cancer Research News
August 10, 2004 • Volume 1 / Number 32 E-Mail This Document  |  Download PDF  |  Bulletin Archive/Search  |  Subscribe

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Special ReportSpecial Report

Impact of Cancer on Fertility Becomes Big Survivorship Issue

Cancer survivor Lindsay Nohr Beck started the Fertile Hope organization in 2001 when she learned that, although almost all patients who receive chemotherapy during their reproductive years are at risk for damage to their fertility capacity, only half of those individuals are informed by their doctors of those risks - and the options to counteract them.

"That's something we've worked really hard to change over the last few years," Ms. Beck recalls. "We're now at the 'tipping point.' This has become a hot topic and oncologists are listening. They want to know the options and where to refer patients." Years before, when Ms. Beck had a recurrence of cancer of the tongue at age 24, she was dismayed to find that there was little information available on options to preserve her childbearing ability after chemotherapy. At almost the last second, she found a local hospital that offered the then-new technology of egg freezing, which she was able to do before starting her treatment.

Clear signs that the impact of cancer on fertility has become a top survivorship issue were made evident at a 3-day international conference on "Parenthood After Cancer" held last March at the M.D. Anderson Cancer Center in Houston. Ms. Beck spoke at the conference along with about 50 other researchers, ethicists, and clinicians. The meeting drew 110 attendees from 13 countries.

Conference chairperson Dr. Leslie Schover, professor of behavioral science at M.D. Anderson, was pleased by the spirit of collaboration shown by the basic scientists and those clinicians involved in treating cancer patients and counseling them about risks and options for fertility-sparing treatment.

Attendees were informed about a number of exciting new research findings and reproductive technologies that are rapidly improving the outlook for cancer patients to have children without fear of endangering the fetus or mother. They included a report by Cornell University infertility specialist Dr. Kutluk Oktay who described a method for freezing ovarian tissue before a woman has chemotherapy and then reimplanting the tissue into the woman and reactivating its egg-producing capability. In a study reported in Lancet after the conference, Dr. Oktay reported that he and his colleagues were able to successfully reimplant ovarian tissue in a woman 6 years after the tissue was frozen, and harvest an oocyte that was fertilized in the lab, with development of an embryo. Unfortunately, a pregnancy did not result when the embryo was returned to the woman's uterus.

Dr. Schover said new developments were also reported on sperm banking, which has been an option for men for many years. "For prepubertal boys there are some ongoing, exciting experiments trying to take the stem cells that produce mature sperm cells from the testes, freeze them, and later on be able transplant them back [to restore fertility]". Preteen boys are more likely than their female peers to be rendered infertile by cancer treatment, she noted.

Another study first reported at the conference by Harvard's Dr. Jonathan Tilly - later published in Nature - could overturn the long-held belief that a woman is born with a fixed number of eggs. Dr. Schover said Dr. Tilly's research in mice suggested that "there may be stem cells in the ovaries that continue to produce new primordial follicles" and germ cells. Dr. Tilly believes that this is likely also the case in humans, holding the promise of restoring or prolonging the fertility of young cancer patients, Schover explained.

Lindsay Beck applauded NCI's leadership, especially from Dr. Julia Rowland and NCI's Office of Survivorship, in making fertility an important issue of concern. She noted NCI's cosponsorship of the March conference and added, "NCI has been great in identifying and promoting survivorship as an area of interest, including working to address fertility."

Despite the rapid progress, much remains to be done to overcome the barriers of lack of information, insurance coverage, and doctor-patient communication about this important area, Ms. Beck said. "I try to make sure that patients feel hopeful, whether they're before treatment, in the midst of it, or afterwards. There are options every single step of the way to start a family and become a parent."

Genetic Testing Shapes Fertility Plans

Women were less likely to want additional children after learning from genetic testing that they are carriers of a hereditary mutation associated with increased risks of breast and ovarian cancer, according to a study published in the May issue of Cancer Epidemiology Biomarkers & Prevention.

In a study of 101 men and women of childbearing age, who are descendants of a Utah family line with the inheritable BRCA1 gene mutation, researchers found that "female carriers were less likely to want additional children compared with female noncarriers" after being informed of their test results. When interviewed 4 months after the testing, only 28 percent of female carriers expressed an interest in having more children, compared with 67 percent of the noncarrier group.

The study also found that people who chose not to learn the results of their genetic testing also "have significantly lower intentions to have additional children than noncarriers."

In contrast, men who found out they are carriers of the BRCA1 mutation differed little from their noncarrier counterparts in the desire to have more children. However, none of the husbands of the female carriers "indicated a desire for additional children, while half the husbands of noncarrier wives did."