Pregnancy After Cancer: New Directions in Fertility Preservation
Rosaria Usini was 23 years old, had just finished college, and was beginning her teaching career when she heard the words she dreaded most, “The cancer is back.”
Rosaria was first diagnosed with Hodgkin lymphoma when she was 17, for which she received chemotherapy and radiation. But this time, her oncologist told her she needed to have a stem-cell transplant. Before she had this life-saving procedure, however, her oncologist said she should make a quick decision — Did she ever want to have children?
As a single person in college, Rosaria hadn’t thought much about children. But coming from a large, loving Italian family, she imagined she would one day get married and give birth. So before starting the stem-cell transplant treatment, Rosaria visited the fertility specialist at the hospital where she was being treated.
Now, 12 years later, Rosaria and her husband returned to the same team of specialists at the Innovation Institute for Fertility Preservation and IVF, and she became a part of a groundbreaking study that gives hope to many young women with cancer.
Fertility Preservation Methods
Currently, there are several ways for women to preserve their fertility.
Cryopreservation. Some women choose to have a procedure to retrieve some of their eggs and preserve them using cryopreservation (freezing the eggs at a very low temperature).
Embryo preservation. Women who have a committed partner or choose to use a sperm donor can create and preserve fertilized embryos, which improves their chances of a successful pregnancy later.
Ovarian transplant. The third way to maintain fertility in patients with cancer is called “ovarian cryopreservation and transplantation.” This new approach involves the removal and freezing of healthy ovarian tissue before the patient undergoes cancer treatment. Years later, when the patient is free of cancer and ready to have a family, a surgeon re-implants the tissue in the pelvis, with the goal of restoring ovarian function, effectively reversing early menopause.
Ovarian Transplants
Ovarian transplants have a number of advantages over other fertility preservation methods. Unlike egg harvesting, ovarian tissue removal does not require delaying cancer treatment while the eggs are being prepared for harvesting, nor does it require hormone stimulation, which can aggravate hormone-sensitive cancers. In fact, ovarian transplant is the only fertility preservation technique that can restore natural hormone production and reverse menopause. Ovarian transplants also provide the possibility for natural conception after treatment. Furthermore, prepubescent girls who have cancer can also use this procedure.
Despite the growing number of healthy babies born after ovarian transplants, the procedure still has some drawbacks, which is why many fertility specialists still consider the procedure experimental. For instance, even successful transplants often only restore fertility for a limited period; for example, the success of the transplant relies on whether the body is naturally able to restore blood circulation to the transplanted tissue.
Back to Rosaria’s Story
As Founder and Director of the Innovation Institute for Fertility Preservation, I offered Rosaria the opportunity to try the ovarian transplant procedure. This new procedure uses robotic assistance to insert a new biomaterial called extracellular tissue matrix (ECTM), along with the ovarian tissue into the remaining nonfunctioning ovary. Surgeons have used ECTM in recent years in certain surgeries, particularly in cosmetic surgeries, to help heal the tissue and aid blood circulation to the area.
But the procedure had never been used for reproductive surgery before the case of Rosaria. The team of specialists at the Innovation Institute believed that ECTM would aid blood flow to the ovaries and improve the success of the procedure. They tried it on Rosaria, and it worked!
After the procedure, Rosaria’s failing ovaries began to function again. The ovarian response to fertility drugs was much more robust compared with older transplant techniques. After 1 round of in vitro fertilization, Rosaria was pregnant with a baby girl. Today, Rosaria and her husband have a healthy 9-month-old daughter, Giuliana Hope. Rosaria has 7 remaining frozen embryos, which were also generated from the frozen and then transplanted ovary, should she desire a larger family.
A Second Successful Patient Case
The team of fertility specialists at the Innovation Institute performed the same new transplant procedure on another young woman who was previously diagnosed with a rare blood disorder that acts like cancer and requires chemotherapy before stem-cell transplantation can be performed. She had a similar response to the procedure and has recently delivered a healthy baby.
While these are only the first-ever pregnancies from the new transplant surgery,1 the success of the procedure should give hope to many young women who are concerned about having children because of cancer. Furthermore, the success of the procedure may help parents of young girls with cancer to consider freezing their daughters’ ovarian tissue, giving them the option to have a transplant later in life.
Reference
- Oktay K, et al. First pregnancies, live birth, and in vitro fertilization outcomes after transplantation of frozen-banked ovarian tissue with a human extracellular matrix scaffold using robot-assisted minimally invasive surgery. American Journal of Obstetrics & Gynecology. 2016;214:94.e1–9.
About the Author
Dr. Oktay is a Professor of Obstetrics & Gynecology, Medicine, and Cell Biology and Anatomy, and Director of the Innovation Institute for Fertility Preservation and IVF, New York; Director, Division of Reproductive Medicine & Infertility, and Laboratory of Molecular Reproduction & Fertility Preservation, New York Medical College, Valhalla, NY. He performed the world’s first ovarian transplant and has pioneered new ovarian stimulation protocols. You can reach him at koktay@fertilitypreservation.org.
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