women don’t have the option for renewal
of that pool. Total body radiation has a
high likelihood of sterilizing both men
and women. Some cyclophosphamides,
a type of chemotherapy drug, also have
a high likelihood of leading to infertility.
Sometimes infertility can be the result
of accumulated effects of more than one
treatment. Finding ways to focus radiation
more specifically and using less radiation in
pediatrics have both been really important
in reducing infertility. And the targeted
therapies that are now being developed
may be less toxic than chemotherapy.
C T: What treatments are available to
preserve fertility for cancer patients?
WOODRUFF: Women 18 and older who
have time can use available technologies
like IVF, which results in eggs that can be
frozen. Cryopreserving eggs is important
for women who are in a young relationship or just dating and don’t want to create
embryos at the time of a cancer diagnosis.
For prepubertal and young adolescent
girls, cryopreserving an ovarian biopsy is
the option. It is an experimental option for
young girls. But in adults, more than 80
babies have been born around the world
from cryopreserved ovaries removed
from women before cancer treatment and
For men and adolescent boys, sperm
banking is the option. If there’s no sperm
in the ejaculate, one can do a TESE
procedure, testicular semen extrac-
tion, a surgical biopsy of the testis. For
prepubertal boys, a portion of the testis
is removed and cryopreserved, but this
treatment is still in the experimental
stage, too. In cryopreserving the tissues,
we’re banking that the research we’re
doing will develop and catch up with the
needs of the patient in the future.
CT: What advice would you give someone
who has received a cancer diagnosis and
wants to preserve fertility?
WOODRUFF: I would refer that individual to an oncofertility patient navigator
here at Northwestern or at almost any of
the 98 sites around the United States the
Oncofertility Consortium has set up. We
have a national hotline, too, the Fertline,
which allows patients to be connected
with a navigator: 866-708-FERT.
CT: Are health insurance plans likely to
cover oncofertility procedures?
WOODRUFF: In the past, you had to
prove you were infertile before your
plan would kick in. But in oncofertility, you have to store embryos, eggs or
ovarian tissue before that first sterilizing
treatment. We generally use the cancer
diagnosis to code for the oncofertility
consultation. Then, in many cases, it’s
covered—but not always.
C T: Should the parents of very young
children diagnosed with cancer be
thinking about oncofertility?
WOODRUFF: Those parents are making
a lot of difficult decisions in the moment.
The easiest decision they’ll make is
to bank on their child’s surviving the
cancer and wanting to have fertility. We
also want to preserve endocrine health.
The hormones of the ovary, the estrogens and progesterones, are absolutely
necessary for taking girls through all
the signatures of development, and the
same is true for boys. Children who lose
gonadal function now have to be enabled
to go through puberty with exogenous
hormones, and that hormone treatment will be lifelong. The hope is that
in the future we will be able to restore
endocrine health to those young cancer
patients using organ mimics or cryopreserved tissue from their own gonads.
The Oncofertility Consortium’s Clinic/Center
Explorer helps patients find fertility preservation
Cancer patients can call the Fertline to talk with a
patient navigator about fertility. 866-708-FERT