Oncofertility Fertility Preservation for Cancer Survivors Cancer Treatment and Research Steven T. Rosen, M.D., Series Editor Pienta, K.J. (ed.): Diagnosis and Treatment of Genitourinary Malignancies. 1996. ISBN 0-7923-4164-3. Arnold, A.J. (ed.): Endocrine Neoplasms. 1997. ISBN 0-7923-4354-9. Pollock, R.E. (ed.): Surgical Oncology. 1997. ISBN 0-7923-9900-5. Verweij, J., Pinedo, H.M., Suit, H.D. (eds): Soft Tissue Sarcomas: Present Achievements and Future Prospects. 1997. ISBN 0-7923-9913-7. Walterhouse, D.O., Cohn, S. L. (eds): Diagnostic and Therapeutic Advances in Pediatric Oncology. 1997. ISBN 0-7923-9978-1. Mittal, B.B., Purdy, J.A., Ang, K.K. (eds): Radiation Therapy. 1998. ISBN 0-7923-9981-1. Foon, K.A., Muss, H.B. (eds): Biological and Hormonal Therapies of Cancer. 1998. ISBN 0-7923-9997-8. Ozols, R.F. (ed.): Gynecologic Oncology. 1998. ISBN 0-7923-8070-3. Noskin, G.A. (ed.): Management of Infectious Complications in Cancer Patients. 1998. ISBN 0-7923-8150-5. Bennett, C.L. (ed.): Cancer Policy. 1998. ISBN 0-7923-8203-X. Benson, A.B. (ed.): Gastrointestinal Oncology. 1998. ISBN 0-7923-8205-6. Tallman, M.S., Gordon, L.I. (eds): Diagnostic and Therapeutic Advances in Hematologic Malignancies. 1998. ISBN 0-7923-8206-4. von Gunten, C.F. (ed.): Palliative Care and Rehabilitation of Cancer Patients. 1999. ISBN 0-7923-8525-X. Burt, R.K., Brush, M.M. (eds): Advances in Allogeneic Hematopoietic Stem Cell Transplantation. 1999. ISBN 0-7923-7714-1. Angelos, P. (ed.): Ethical Issues in Cancer Patient Care 2000. ISBN 0-7923-7726-5. Gradishar, W.J., Wood, W.C. (eds): Advances in Breast Cancer Management. 2000. ISBN 0-7923-7890-3. Sparano, J.A. (ed.): HIV & HTLV-I Associated Malignancies. 2001. ISBN 0-7923-7220-4. Ettinger, D.S. (ed.): Thoracic Oncology. 2001. ISBN 0-7923-7248-4. Bergan, R.C. (ed.): Cancer Chemoprevention. 2001. ISBN 0-7923-7259-X. Raza, A., Mundle, S.D. (eds): Myelodysplastic Syndromes & Secondary Acute Myelogenous Leukemia 2001. ISBN 0-7923-7396. Talamonti, M.S. (ed.): Liver Directed Therapy for Primary and Metastatic Liver Tumors. 2001. ISBN 0-7923-7523-8. Stack, M.S., Fishman, D.A. (eds): Ovarian Cancer. 2001. ISBN 0-7923-7530-0. Bashey, A., Ball, E.D. (eds): Non-Myeloablative Allogeneic Transplantation. 2002. ISBN 0-7923-7646-3. Leong, S.P.L. (ed.): Atlas of Selective Sentinel Lymphadenectomy for Melanoma, Breast Cancer and Colon Cancer. 2002. ISBN 1-4020-7013-6. Andersson, B., Murray D. (eds): Clinically Relevant Resistance in Cancer Chemotherapy. 2002. ISBN 1-4020-7200-7. Beam, C. (ed.): Biostatistical Applications in Cancer Research. 2002. ISBN 1-4020-7226-0. Brockstein, B., Masters, G. (eds): Head and Neck Cancer. 2003. ISBN 1-4020-7336-4. Frank, D.A. (ed.): Signal Transduction in Cancer. 2003. ISBN 1-4020-7340-2. (continued after index) Oncofertility Fertility Preservation for Cancer Survivors edited by Teresa K. Woodruff, PhD The Thomas J. Watkins Professor of Obstetrics and Gynecology Director, Institute for Women’s Health Research Chief, Division of Fertility Preservation Associate Director, Basic Science Programs, The Robert H. Lurie Comprehensive Cancer Center Director, Center for Reproductive Research Feinberg School of Medicine Northwestern University Chicago, Illinois, USA Karrie Ann Snyder, PhD Research Assistant Professor Institute for Women’s Health Research Feinberg School of Medicine Northwestern University Chicago, Illinois, USA Teresa K. Woodruff, PhD Karrie Ann Snyder, PhD Institute for Women’s Health Research Institute for Women’s Health Research Division of Fertility Preservation Feinberg School of Medicine Department of Obstetrics and Gynecology Northwestern University Feinberg School of Medicine Chicago, IL 60611 USA Northwestern University Chicago, IL 60611 USA Series Editor: Steven T. Rosen Robert H. Lurie Comprehensive Cancer Center Northwestern University Chicago, IL USA Oncofertility: Fertility Preservations for Cancer Survivors ISBN-13: 978-0-387-72292-4 e-ISBN-13: 978-0-387-72293-1 Library of Congress Control Number: 2007925436 © 2007 Springer Science+Business Media, LLC All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer Science+Business Media, LLC, 233 Spring Street, New York, NY-10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights. Printed on acid-free paper. 9 8 7 6 5 4 3 2 1 springer.com Foreword It has been our pleasure to edit the first book on an interdisciplinary science we call oncofertility. Oncofertility bridges traditional areas of basic science and medical research, brings together oncologists and fertility specialists, and hopes to provide real options to young people who survive life-preserving but fertility-threatening treatments for cancer. The chapters in this book range from basic discovery research to reproductive medicine and from social science and the humanities to a section on stories from those who have survived cancer and have faced issues of fertility deprivation or restoration. Specifically, we have addressed three main areas: the underlying biological questions surrounding follicle growth and cryo-preservation of tissue; the application of the new technology to medical practice; and, the psychosocial implications of cancer-related infertility and oncofertility research for patients and their families. These questions are interlinking and require teams of investigators working in concert to solve a major unmet need. The book is a comprehensive initial definition of the field and we anticipate a great many more breakthroughs that will eventually provide a menu of options to those with fertility-threatening conditions. The editors thank the Specialized Cooperative Centers Program in Reproduction and Infertility Research (U54 HD041857) and the Institute for Women’s Health Research of Northwestern University for funding and support of this book. Teresa K. Woodruff Karrie Ann Snyder v vi Foreword Foreword As young women who faced both cancer and the potential loss of our ability to have children, we are extremely gratified by the efforts of the scientists, clinicians and social scientists who have come together to recognize, validate and tackle this criti- cal issue. When we were diagnosed, there was little discussion of the physical impact of the life-preserving cancer treatments; and virtually no acknowledgement of the life-altering significance of that potential loss. It is exciting, therefore, to see the interdisciplinary, multifaceted approach that is now being put into place to meet the fertility needs of young adults diagnosed with cancer. We know that this semi- nal work in the field of oncofertility will set the stage for many more volumes as the field develops and the progress achieved makes more fertility-preserving options a reality for women just like us. – Lindsay Beck Founder and Executive Director, Fertile Hope – Joyce Reinecke, JD Program Director, Fertile Hope vii Contents Foreword. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v Teresa K. Woodruff and Karrie Ann Snyder Foreword. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii Lindsay Beck and Joyce Reinecke Contributors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvii Part I Introduction 1. The Emergence of a New Interdiscipline: Oncofertility . . . . . . . . . . . . 3 Teresa K. Woodruff Oncofertility: The New Offensive in the War on Cancer. . . . . . . . . . . . . . 3 Secondary Effects of Treatment on the Health and Quality of Life of Young Survivors of Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Fertility Threats Due to Cancer Treatment. . . . . . . . . . . . . . . . . . . . . . . . . 5 An Emerging Urgent Unment Need for Young Cancer Patients: Balancing Life-Preserving but Fertility-Threatening Cancer Treatments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Information GAP. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Data GAP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Option GAP. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Part II Fertility Risk and Treatment Options 2. Fertility Management for Women With Cancer . . . . . . . . . . . . . . . . . . 15 Sanjay K. Agarwal and R. Jeffrey Chang Ovarian Physiology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Impact of Cancer Therapies on Ovarian Function . . . . . . . . . . . . . . . . . . . 18 Current Techniques of Fertility Preservation . . . . . . . . . . . . . . . . . . . . . . . 20 Embryo Freezing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Ovarian Tissue Freezing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 ix x Contents Oocyte Freezing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Future Directions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 3. Fertility Preservation in Adult Male Cancer Patients. . . . . . . . . . . . . . 28 Robert E. Brannigan The Impact of Cancer on Male Reproductive Health. . . . . . . . . . . . . . . . . 28 Endocrine Effects of Tumors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Cytotoxic Autoimmune Response . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Systemic Physiological Changes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Psychological Changes Associated with Cancer . . . . . . . . . . . . . . . . . . . . 31 The Impact of Cancer Treatment on Male Reproductive Health . . . . . . . . 32 Effects of Radiation Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Effects of Chemotherapy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Effects of Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Effects of Opiods. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Fertility Preservation in Male Cancer Patients. . . . . . . . . . . . . . . . . . . . . . 39 American Society of Clinical Oncology Guidelines . . . . . . . . . . . . . . . . . . 40 Sperm Cryopreservation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Overview of Sperm Collection Techniques. . . . . . . . . . . . . . . . . . . . . . . . . 42 Testicular Tissue Cryopreservation (ONCO-TESE). . . . . . . . . . . . . . . . . . 42 Future Directions in Fertility Preservation in Male Cancer Patients . . . . . 45 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 4. Managing Fertility in Childhood Cancer Patients. . . . . . . . . . . . . . . . . 50 Kimberley J. Dilley Follow-up Guidelines Related to Male Fertility. . . . . . . . . . . . . . . . . . . . . 51 Risk Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 Surveillance and Screening. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 Additional Management Issues. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Follow-up Guidelines Related to Female Fertility . . . . . . . . . . . . . . . . . . . 52 Risk Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Surveillance and Screening. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Additional Management Issues. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 Optimal Care for Pediatric Cancer Patients . . . . . . . . . . . . . . . . . . . . . . . . 54 References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 5. Fertility Risk in Pediatric and Adolescent Cancers. . . . . . . . . . . . . . . . 57 Clarisa R. Gracia and Jill P. Ginsberg Scope of the Problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 The Importance of Fertility to Cancer Patients. . . . . . . . . . . . . . . . . . . . . . 57