What Options (and When) to Consider for Fertility Preservation
Recently, our very own Jennifer Levine, contributed to an abstract on premature menopause and the reproductive implications in survivors of childhood cancer. Dr. Levine has been active in helping to standardize guidelines for fertility preservation for children, adolescents and young adults through the European Group PanCare and a member of the International Harmonization Guidelines section on female Fertility Preservation.
This study was a review of data that was collected by the Childhood Cancer Survivor Study, a multi-institutional study that uses questionnaires and chart review to identify late effects in survivors of childhood cancer.
“We reviewed patient exposures to chemotherapy and radiation as well as their answer to questions on the surveys that identified menstrual status and pregnancy/live birth data,” Dr. Levine explained. “We then evaluated what exposures were statistically correlated with early entry into menopause. We also then compared pregnancy and live birth rates between those who had evidence of premature menopause versus those who did not.”
Overall, while the rates of premature menopause were low in this population (median age at diagnosis of six), these data are necessarily applicable to an older population, for example, those diagnosed as young adults. This study did show that childhood survivors were at risk for early menopause and less likely to ever have a live birth than their healthy siblings. These outcomes were most prevalent in those survivors who had high levels of procarbazine, any ovarian radiation and those receiving stem cell transplants.
The study did not evaluate methods of fertility preservation, but Dr. Levine recommends certain courses of action depending on the particular diagnosis, and on age at diagnosis:
- Ovarian tissue cryopreservation at diagnosis in pre-pubertal patients who are at high-risk of ovarian failure from their treatment
- Egg freezing or ovarian tissue freezing at diagnosis in post pubertal females at high-risk of ovarian failure
- Egg freezing after treatment as well for those females who have a high likelihood of premature menopause
As is the case with most fertility treatments unfortunately, the biggest barrier to accessing these methods is financial, as most insurance companies do not cover the costs of fertility preservation. This is, of course, something the Alliance for Fertility Preservation aims to continue to shine the light on and help create access for those who need it.
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