To foster collaboration among physicians from different disciplines regarding the impact of chemotherapy and radiotherapy on fertility, Dr. Ariel Revel, senior physician in the Hadassah Medical Center’s Department of Obstetrics and Gynecology, organized a July conference which was attended by more than 250 physicians–oncologists, hematologists, radiotherapists, psycho-oncologists, and gynecologists/obstetricians from all over the country.
Seventeen Hadassah experts gave presentations from the perspective of their specialties. Hematologist Ora Paltiel described new chemotherapy protocols that can often be substituted for the old regimen which has been deadly to the gonads. Radiotherapist Marc Wygoda explained newer technologies that focus the radiation beam directly on the tumor, thus sparing surrounding tissues.
Prof. Reuven Or, head of Hadassah’s Bone Marrow Transplantation Unit, reported that about 99 percent of women patients fail to become pregnant after bone marrow transplantation procedures, which put patients even as young as 20 into a menopausal state. Psycho-oncologist Michal Braun related that all patients, both men and women, are anxious about the impact of cancer treatment on their fertility. In fact, she noted, “Many women will choose a less aggressive treatment for their cancer, even though it lowers their chances of recovery and survival, if it leaves their fertility intact.”
At Hadassah and worldwide, medical avenues are being explored to safeguard fertility from the adverse effects of chemotherapy. One is administering medication during chemotherapy to protect healthy ovarian tissue. As yet, none has proven effective. When possible, oocytes (egg cells) are removed and frozen before administering chemotherapy. Best results have been achieved with a rapid freezing technique called vitrification.
Because pre-teens have no mature egg cells to freeze, they would be the beneficiaries of research that Dr. Revel and his team are conducting in the field of cryo-preservation of entire slices of ovary. “We’re hopeful that this technique would work not only for youngsters, but also allow women to conceive naturally when these slices are successfully re-implanted,” he says.
Problems remain to be solved, however. For example, the ovary sliver is not re-implanted with blood vessels, so most of its egg cells die. Furthermore, since the cells are removed from the patient when she already has cancer, there is a risk of reinfection.
The removal and replacement of slices of testicular tissue are also being explored, says Dr. Revel. “We’re hopeful,” he notes, “that re-implantation of testicular tissue can renew spermatogenesis.”
The information above was excerpted from an article especially written for the Hadassah Medical Center by Wendy Elliman.
