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Affdal AO, Salama M, Ravitsky V. Ethical, legal, social, and policy issues of ovarian tissue cryopreservation in prepubertal girls: a critical interpretive review. J Assist Reprod Genet 2024; 41:999-1026. [PMID: 38430324 PMCID: PMC11052756 DOI: 10.1007/s10815-024-03059-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 02/07/2024] [Indexed: 03/03/2024] Open
Abstract
PURPOSE Despite the increasing number of childhood cancer survivors, significant advances in ovarian tissue cryopreservation (OTC) technique and medical societies' recommendations, fertility preservation (FP) and FP discussions are not always offered as a standard of care in the pediatric context. The aim of this literature review is to understand what ethical, legal, social, and policy issues may influence the provision of FP by OTC in prepubertal girls with cancer. METHODS A critical interpretive review of peer-reviewed papers published between 2000 and January 2023 was conducted, guided by the McDougall's version of the critical interpretive synthesis (Dixon-Woods), to capture recurring concepts, principles, and arguments regarding FP by OTC for prepubertal girls. RESULTS Of 931 potentially relevant papers, 162 were included in our analysis. Data were grouped into seven thematic categories: (1) risks of the procedure, (2) unique decision-making issues in pediatric oncofertility, (3) counseling, (4) cultural and cost issues, and (5) disposition of cryopreserved reproductive tissue. CONCLUSION This first literature review focusing on ethical, legal, social, and policy issues surrounding OTC in prepubertal girls highlights concerns in the oncofertility debate. Although OTC is no longer experimental as of December 2019, these issues could limit its availability and the child's future reproductive autonomy. This review concludes that specific actions must be provided to enable the offer of FP, such as supporting families' decision-making in this unique and complex context, and providing pediatric patients universal and full access to free or highly subsidized OTC.
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Affiliation(s)
| | | | - Vardit Ravitsky
- University of Montreal, Montreal, Canada
- The Hastings Center, Garrison, USA
- Harvard Medical School, Boston, USA
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Fernbach A, Lockart B, Armus CL, Bashore LM, Levine J, Kroon L, Sylvain G, Rodgers C. Evidence-Based Recommendations for Fertility Preservation Options for Inclusion in Treatment Protocols for Pediatric and Adolescent Patients Diagnosed With Cancer. J Pediatr Oncol Nurs 2014; 31:211-222. [PMID: 24799444 PMCID: PMC5213740 DOI: 10.1177/1043454214532025] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
As survival rates improve for pediatric cancers, increased attention has been paid to late effects of cancer therapy, in particular, infertility. Fertility preservation options are available for pre- and postpubertal cancer patients; however, many providers lack knowledge regarding options. The aim of this article is to provide a comprehensive synthesis of current evidence and recommendations regarding fertility preservation options for children, adolescents, and young adults undergoing cancer treatment. A systematic search was performed to identify fertility preservation evidence. Fifty-three studies and 4 clinical guidelines were used for the review. Final recommendations consisted of 2 strong and 1 weak recommendation for both female and male fertility preservation options. The treatment team should be knowledgeable about fertility preservation so that they can educate patients and families about available fertility preservation options. It is important to consider and discuss all available fertility options with patients at the time of diagnosis.
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Affiliation(s)
| | | | - Cheryl L Armus
- MACC Fund Center for Cancer and Blood Disorders, Milwaukee, WI, USA
| | - Lisa M Bashore
- Life After Cancer Program, Cook Children's Medical Center, Fort Worth, TX, USA
| | | | - Leah Kroon
- Seattle Children's Hospital, Seattle, WA, USA
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Tichelli A, Rovó A. Fertility issues following hematopoietic stem cell transplantation. Expert Rev Hematol 2014; 6:375-88. [DOI: 10.1586/17474086.2013.816507] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Ahn RW, Barrett SL, Raja MR, Jozefik JK, Spaho L, Chen H, Bally MB, Mazar AP, Avram MJ, Winter JN, Gordon LI, Shea LD, O’Halloran TV, Woodruff TK. Nano-encapsulation of arsenic trioxide enhances efficacy against murine lymphoma model while minimizing its impact on ovarian reserve in vitro and in vivo. PLoS One 2013; 8:e58491. [PMID: 23526987 PMCID: PMC3603968 DOI: 10.1371/journal.pone.0058491] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 02/07/2013] [Indexed: 12/20/2022] Open
Abstract
Advances in cancer therapy have increased the rate of survival of young cancer patients; however, female lymphoma patients frequently face a temporary or permanent loss of fertility when treated with traditional cytotoxic agents. The potential loss of fertility is an important concern that can influence treatment decisions for many premenopausal cancer patients. The negative effect of chemotherapeutic agents and treatment protocols to patients’ fertility–referred to as fertotoxicity–are thus an increasingly important cancer survivorship issue. We have developed a novel nanoscale formulation of arsenic trioxide, a potent drug for treatment of hematological malignancies, and demonstrate that it has significantly better activity in a murine lymphoma model than the free drug. In parallel, we have developed a novel in vitro assay of ovarian follicle function that predicts in vivo ovarian toxicity of therapeutic agents. Our results reveal that the nanotherapeutic agent is not only more active against lymphoma, but is fertoprotective, i.e., it is much less deleterious to ovarian function than the parent drug. Thus, our in vitro assay allows rapid evaluation of both established and experimental anticancer drugs on ovarian reserve and can inform the selection of efficacious and fertility-sparing treatment regimens for reproductive-age women diagnosed with cancer.
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Affiliation(s)
- Richard W. Ahn
- Department of Chemistry, Chemistry of Life Processes Institute, Northwestern University, Evanston, Illinois, United States of America
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois, United States of America
- Member of the Oncofertility Consortium, Northwestern University, Chicago, Illinois, United States of America
| | - Susan L. Barrett
- Member of the Oncofertility Consortium, Northwestern University, Chicago, Illinois, United States of America
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois, United States of America
- Center for Reproductive Science Reproductive Biology Training Program, Northwestern University, Evanston, Illinois, United States of America
| | - Meera R. Raja
- Department of Chemistry, Chemistry of Life Processes Institute, Northwestern University, Evanston, Illinois, United States of America
| | - Jennifer K. Jozefik
- Member of the Oncofertility Consortium, Northwestern University, Chicago, Illinois, United States of America
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois, United States of America
| | - Lidia Spaho
- Member of the Oncofertility Consortium, Northwestern University, Chicago, Illinois, United States of America
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois, United States of America
| | - Haimei Chen
- Department of Chemistry, Chemistry of Life Processes Institute, Northwestern University, Evanston, Illinois, United States of America
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois, United States of America
- Member of the Oncofertility Consortium, Northwestern University, Chicago, Illinois, United States of America
| | - Marcel B. Bally
- Centre for Drug Research and Development, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Advanced Therapeutics, BC Cancer Agency, British Columbia, Canada
| | - Andrew P. Mazar
- Department of Chemistry, Chemistry of Life Processes Institute, Northwestern University, Evanston, Illinois, United States of America
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois, United States of America
| | - Michael J. Avram
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois, United States of America
- Department of Anesthesiology and Mary Beth Donnelley Clinical Pharmacology Core Facility of the Robert H. Lurie Comprehensive Cancer Center of the Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Jane N. Winter
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois, United States of America
- Department of Medicine, Division of Hematology/Oncology and Lymphoma Program, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Leo I. Gordon
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois, United States of America
- Department of Medicine, Division of Hematology/Oncology and Lymphoma Program, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Lonnie D. Shea
- Member of the Oncofertility Consortium, Northwestern University, Chicago, Illinois, United States of America
- Department of Chemical and Biological Engineering, Northwestern University, Evanston, Illinois, United States of America
| | - Thomas V. O’Halloran
- Department of Chemistry, Chemistry of Life Processes Institute, Northwestern University, Evanston, Illinois, United States of America
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois, United States of America
- Member of the Oncofertility Consortium, Northwestern University, Chicago, Illinois, United States of America
- * E-mail: (TVO); (TKW)
| | - Teresa K. Woodruff
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois, United States of America
- Member of the Oncofertility Consortium, Northwestern University, Chicago, Illinois, United States of America
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois, United States of America
- * E-mail: (TVO); (TKW)
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Waimey KE, Duncan FE, Su HI, Smith K, Wallach H, Jona K, Coutifaris C, Gracia CR, Shea LD, Brannigan RE, Chang RJ, Zelinski MB, Stouffer RL, Taylor RL, Woodruff TK. Future Directions in Oncofertility and Fertility Preservation: A Report from the 2011 Oncofertility Consortium Conference. J Adolesc Young Adult Oncol 2013; 2:25-30. [PMID: 23610740 PMCID: PMC3604786 DOI: 10.1089/jayao.2012.0035] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Fertility impairment and loss due to cancer or its treatment is a significant survivorship consideration for many pediatric, adolescent, and young adult cancer survivors. Chemotherapeutics, radiation, and surgery can impact the future fertility of men, women, and children with cancer. The field of oncofertility, founded to ensure the reproductive future of cancer survivors, gained momentum with 5 years of funding through a 2007 National Institutes of Health Roadmap Grant for Biomedical Research. This report from working group meetings at the fifth annual Oncofertility Consortium Conference speaks to the present state of oncofertility research and clinical care, existing gaps, and future directions for the field. This summary from conference participants and leaders in the field addresses the science, clinical specialties, and academic scholarship that can guide the field as the Roadmap Grant funding comes to a close.
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Affiliation(s)
- Kate E. Waimey
- Oncofertility Consortium, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Francesca E. Duncan
- Oncofertility Consortium, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - H. Irene Su
- Department of Reproductive Medicine and Cancer Prevention and Control Program, Moores UCSD Cancer Center, University of California, San Diego, La Jolla, California
| | - Kristin Smith
- Oncofertility Consortium, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Harlan Wallach
- Northwestern University Information Technologies, Northwestern University, Evanston, Illinois
| | - Kemi Jona
- Office of STEM Education Partnerships, Northwestern University, Evanston, Illinois
| | - Christos Coutifaris
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania
| | - Clarisa R. Gracia
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania
| | - Lonnie D. Shea
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- McCormick School of Engineering, Northwestern University, Evanston, Illinois
| | - Robert E. Brannigan
- Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - R. Jeffrey Chang
- Division of Reproductive Endocrinology, University of California at San Diego, San Diego, California
| | - Mary B. Zelinski
- Department of Obstetrics & Gynecology, Division of Reproductive Sciences, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, Oregon
| | - Richard L. Stouffer
- Department of Obstetrics & Gynecology, Division of Reproductive Sciences, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, Oregon
| | - Robert L. Taylor
- Northwestern University Information Technologies, Northwestern University, Evanston, Illinois
| | - Teresa K. Woodruff
- Oncofertility Consortium, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Developing a clinical-grade cryopreservation protocol for human testicular tissue and cells. BIOMED RESEARCH INTERNATIONAL 2013; 2013:930962. [PMID: 23509810 PMCID: PMC3581100 DOI: 10.1155/2013/930962] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2012] [Revised: 11/29/2012] [Accepted: 12/02/2012] [Indexed: 12/31/2022]
Abstract
Recent work in preservation of female fertility as well as new information on the nature of spermatogonial stem cells has prompted an investigation into the possibility of an effective clinical-grade procedure for the cryopreservation of testicular cells and/or tissue. Clinical-grade reagents, validated equipment, and protocols consistent with cGTP/cGMP standards were used in developing a procedure suitable for the safe and effective cryopreservation of human testicular cells and tissues. These procedures were designed to be compliant with the relevant FDA regulations. The procedure proved to effectively cryopreserve both testicular cells and tissue. The cryopreservation of testicular tissue was comparable in most aspects we measured to the cryopreservation of isolated cells, except that the viability of the cells from cryopreserved testicular tissue was found to be significantly higher. On the other hand, cryopreservation of cells is preferred for cell analysis, quality control, and sterility testing. This study demonstrates that testicular tissue and cells from sexual reassignment patients can be successfully cryopreserved with a clinical-grade procedure and important cell populations are not only preserved but also enriched by the process. Further studies will determine whether these findings from hormone-treated patients can be generalized to other patients.
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Köhler TS, Kondapalli LA, Shah A, Chan S, Woodruff TK, Brannigan RE. Results from the survey for preservation of adolescent reproduction (SPARE) study: gender disparity in delivery of fertility preservation message to adolescents with cancer. J Assist Reprod Genet 2010; 28:269-77. [PMID: 21110080 DOI: 10.1007/s10815-010-9504-6] [Citation(s) in RCA: 139] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Accepted: 10/28/2010] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Diminished reproductive capacity is a devastating consequence of life-sparing therapies for childhood malignancy. In 2006, the American Society of Clinical Oncology (ASCO) published fertility preservation recommendations (ASCOR) emphasizing the importance of early discussion and intervention for fertility preservation strategies. Using the Survey for Preservation of Adolescent REproduction (SPARE), we sought to determine fertility preservation attitudes and practice patterns post-ASCOR from pediatric oncology specialists nationwide. MATERIALS AND METHODS The SPARE survey consists of 22 questions assessing pediatric oncology specialists' attitudes and practice patterns toward fertility preservation. Broad perspectives on fertility preservation, including a willingness to discuss fertility, knowledge of current fertility preservation methods and awareness of ASCOR, were assessed. RESULTS The majority of respondents acknowledged that fertility threats are a major concern for them and agreed that all pubertal cancer patients should be offered a fertility consultation, but only 46% reported they refer male pubertal cancer patients to a fertility specialist prior to cancer treatment >50% of the time, and only 12% reported they refer female pubertal cancer patients to a fertility specialist prior to cancer treatment > 50% of the time. While 44% of respondents were familiar with the 2006 ASCOR, only 39% of those utilized them to guide decision-making in greater than half of their patients. CONCLUSION Our study demonstrates pediatric oncologists' motivation to preserve fertility in pediatric cancer patients; however, barriers to both gamete cryopreservation and referral to fertility specialists persist. Female pubertal patients are referred to fertility preservation specialists with much less frequency than are male pubertal patients, highlighting a disparity.
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Affiliation(s)
- Tobias S Köhler
- Division of Urology, Southern Illinois University School of Medicine, Springfield, IL, USA
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Affiliation(s)
- Clarisa R Gracia
- Department of Reproductive Endocrinology and Infertility, University of Pennsylvania, Philadelphia, PA, USA.
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Affiliation(s)
- Susan L Barrett
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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Affiliation(s)
- Jacqueline S Jeruss
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
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