Nice article on SF chronicle today.
I was involved in Lindsay's organization "Fertile Hope", as her doctor, Dr Lynn Westphal at Stanford was also my doctor. Being diagnosed with cancer is hard enough, but having a fear of unable to have children in the future is also tough. This week 2 years ago was my last chemotherapy treatment. I must say that I'm so proud that I made a right choice to preserve my fertility. When I met Lindsay in person, I thanked her and my tears came out, because what she did changed my life. I hope I could be someone who can encourage young cancer patients.
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(http://www.sfgate.com/cgi-bin/article.cgi?file=/c/a/2010/05/28/MNGB1DIMMC.DTL)
Friday, May 28, 2010 (SF Chronicle)
Fertility preservation helps women beyond cancer
Erin Allday, Chronicle Staff Writer
(05-28) 10:44 PDT SAN FRANCISCO -- Lindsay Beck had successfully fought
cancer once, but when it returned in 2000, her doctor told her she would
need more aggressive treatment - chemotherapy. He read her a list of
possible side effects but never mentioned that it might leave her sterile.
It was only when Beck asked about it that her doctor said yes, the drugs
would almost definitely attack her ovaries and essentially send her into
early menopause. It might be impossible for her to have children of her
own. Beck was 24.
"He said, 'Let's focus on saving you first. If you're not alive in five
years, having a baby isn't an issue,' " Beck said. "I agreed, of course.
But I thought there must be something I can do now."
There was. Beck's oncologist didn't know it, but through tenacious
research and multiple calls to Bay Area fertility clinics, Beck found a
doctor at Stanford University who was willing to freeze some of her eggs.
Ideally they'd keep for many years, and when Beck was healthy and ready to
start a family, the eggs could be thawed and fertilized.
Fertility preservation is a relatively new but quickly growing field of
medicine, devoted to helping women protect their ability to have children
before starting toxic but lifesaving drug treatments that may damage their
reproductive organs.
Many chemotherapy drugs - especially those used to treat breast cancer -
target fast-growing cells, including the ovarian tissues that ripen and
release eggs. The drugs can shave 10 years off a woman's fertile years.
For women in their 30s, there can be another issue: By the time they're
done with treatment and healthy again, they may be in their 40s, and
conceiving children might be out of reach. Left in the dark
Both UCSF and Stanford have departments dedicated to fertility
preservation, with reproductive experts who work specifically with
patients who have cancer or other diseases that pose a risk to
reproductive organs. But to the frustration of fertility experts and
patients, many women still aren't being told that sterility is a possible
side effect of cancer treatment - and more important, that they may be
able to protect themselves.
The patients whom oncologists see tend to be older and well past having
children, said Dr. Lynn Westphal, a reproductive endocrinologist at
Stanford who froze Beck's eggs.
"So fertility isn't the first thing on their mind," she said. "They're
focused on curing the patient, and that's where their focus should be. But
the patients want to look past their cancer."
To be sure, there are limits to what fertility preservation can
accomplish, and who it can help. Embryos tend to have the best success
rate, as far as resulting in a pregnancy, but they may not be the best
option for women who don't have a partner to fertilize an egg.
The process of harvesting eggs from the ovary usually takes two to four
weeks - involving expensive, daily hormone injections - and some women
diagnosed with cancer are told they need to start chemotherapy
immediately.
Researchers are working to improve a new procedure that involves removing
a small piece of ovarian tissue and freezing it, then transplanting it
back into a woman's body after cancer treatment to reactivate the
reproductive organs.
The advantage is that the procedure can be done right away, and therefore
may be an option for women who don't have time to ready an egg or embryo
for freezing. The disadvantage is that transplanting the tissue may
reintroduce the same cells that caused the initial cancer. Only 10 or so
pregnancies worldwide have resulted from the procedure. Women have options
Still, fertility experts said they're delighted to have options for women
who just a few years ago would almost definitely have lost their ability
to have children after going through cancer treatment.
"One of the most significant long-term implications of cancer treatment is
not being able to build a family and carry on a legacy," said Dr. Mitch
Rosen, director of the UCSF Fertility Preservation Center. "It's like a
double blow. They're cured from the cancer, and then 10 years later, they
can't have a baby, and it's such a significant regret."
Fertility preservation isn't cheap: It can cost $15,000 to freeze eggs or
embryos and $30,000 to freeze ovarian tissue. And very few insurers pay
for preventive fertility therapy. Rosen said he's known women who have
held fundraisers or took out loans to pay for treatment. The Make-a-Wish
Foundation covered the costs of freezing the eggs of one 17-year-old girl,
Rosen said. Source of comfort
UCSF, like Stanford, is now setting up a program to make fertility
preservation procedures affordable for women with cancer.
Beck, the 24-year-old cancer patient, never needed her frozen eggs. She's
34 now, and the Mill Valley woman has had two children who were conceived
naturally. But just knowing that the eggs were waiting for her was a great
source of comfort when she was fighting her cancer, she said.
She created a nonprofit organization to help other women take advantage of
fertility preservation options. Her group, Fertile Hope, was acquired by
Lance Armstrong's LiveStrong foundation last year.
Beck said she was particularly moved into action when she started her
chemotherapy treatment. She was sitting in a clinic with a group of other
young women, all of them hooked up to IVs, and she mentioned she'd just
had her eggs frozen. The other women were shocked - they'd never been told
that their fertility might be at risk, and now it was too late to do
anything.
"I felt really guilty, like I'd kept this secret," she said. "It seemed
ludicrous to me that they didn't know. People were being sterilized
without their knowledge. But there's been a lot of improvement. People are
talking about it now."
Options: More information on fertility preservation. A10
Preserving fertility
Fertility preservation is a field of medicine devoted to helping women
protect their ability to have children before they undergo drug treatments
that may damage their reproductive organs. Procedures involve freezing
eggs, embryos or ovarian tissue, all of which can be preserved for many
years, until a woman is healthy and ready to have children.
Embryo banking: Mature eggs are removed from a woman and fertilized with
sperm. The resulting embryos are frozen for future use.
Egg banking: A woman's ovaries are stimulated to release mature eggs,
which are removed and frozen for future use.
Ovarian tissue banking: Tissue is removed from an ovary and frozen so that
it can be transplanted at a later date. The transplanted tissue can
activate the reproductive organs and kick-start the release of mature
eggs.
Web sites with more information on fertility preservation:
-- UCSF Fertility Preservation Center: www.coe.ucsf.edu/fpc/index.html
-- Stanford Fertility and Reproductive Medicine Center:
www.stanfordivf.com/fertility-preservation.html
-- Oncofertility Consortium at Northwestern University:
www.oncofertility.northwestern.edu
-- Fertile Hope. www.fertilehope.org/
