A pioneer in the world of fertility preservation for young cancer patients, Dr. Teresa Woodruff of Northwestern University’s Feinberg School of Medicine, coined the term oncofertility and champions the idea of looking beyond the lab bench to the cancer patients affected by the studies.
Her research in reproductive endocrinology has increased awareness of fertility management and the role it plays in quality of life for the increasing number of women who are also young cancer survivors.
Woodruff addresses the main concerns and issues facing the field and the patients it is built around.
What is oncofertility and what exactly does that encompass?
Oncofertility is a term to describe a new area of work that is used to provide fertility options to young cancer patients. It involves all the dimensions of a patient’s decision process and provider’s information. It is the ethics, the law, the religious constraints, and the multi-dimensionality of fertility management in the case of a young (ages zero to 40) cancer patient.
What advice do you have for cancer patients concerned with fertility preservation? Where should they start and how can they find specialists that will work with their own doctors?
I think one of the main things is that cancer patients should really ask their doctors about the threat of their treatments to their fertility, because not all treatments are going to result in sterilization. Getting that information upfront is really important.
If their doctors don’t know, they should consult with a fertility specialist. Our oncofertility hotline can give them information about fertility management and their local experts. They don’t have to come to Chicago. There are 60 sites around America and we have partners in Europe, China and throughout the world that support fertility management.
What options are there for cancer patients who are concerned about preserving and managing their fertility?
If you were able to protect your gametes before, it depends on what you protected. You might have gone through IVF and frozen a mature egg. Those mature eggs and ones that are fertilized with a husband’s, boyfriend’s, or a donor’s sperm can be re-transplanted into the patient.
For those who didn’t have their gametes protected, live births have also occurred after re-introducing preserved tissue transplants. However, there is the potential to reintroduce the cancer they just survived so we are working on ways to grow the tissue in culture and produce mature eggs that can be fertilized.
I think it is now 17 live births resulting from tissue culture.
For patients who were not aware or did not have time to access these options then adoption is now an option for them.
What is the most common misconception regarding cancer patients and oncofertility?
The most common misperception is that cancer is a genetic disease and that if a person has cancer that they are going to pass that disease onto their child. Some cancer is heritable, but those cancers only represent 5 percent of the overall cancer burden. What this means is that 95 percent of cancer is spontaneous.
What is your fertility preservation organization called and what was the impetus for its creation?
It is called the Oncofertility Consortium and the impetus for its creation was originally a grant offered by the National Institutes of Health, which asked the scientific community to tell them what the most intractable problems of our day are and how we would solve them.
The origin of the term oncofertility was for that grant and the idea was that fertility preservation, particularly for female cancer patients, was not something that was not being provided at all.
We realized we could intervene by using emerging basic science principles and developing protocols that address the multi-dimensional ways of treating fertility preservation.
Prior to the Oncofertility Consortium, what options existed for cancer patients concerned about fertility preservation?
Actually, not very many. If you were a male you could have sperm banking, but most young women were not being provided that same opportunity or information.
There could have been options for emergency procedures that preserve fertility, but because the oncologists and fertility specialists rarely spoke, getting those two communities to really be engaged in the process became one of the biggest hurdles.
What are the major barriers or challenges facing your cause?
For some cancer patients, fertility preservation means delaying treatment, which is a really difficult decision to make. And of course, preserving an ovary is experimental and invasive, so being at the early stages of this field is an issue because of uncertainty, but really that will come with time.
Are there any specific cases over the years that have continued to resonate with you?
There are many. One involved a young girl who was 16 years old when she was diagnosed. Her family flew to Chicago from Los Angeles to protect her fertility and she is now in college and doing well. During the process she really made a point to advocate with her oncologist that fertility that was important to her, which is not always common in young cancer patients.
We are working really hard to remember that there is a real and tangible person on the other end, which is different than the mentality of traditional science.
You have an awe-inspiring number of appointments and accolades, is there one you are most proud of? Why?
I was asked to give a commencement speech for the Young Women’s Leadership Charter School a couple of years ago for their graduation. That was really exciting to me because I was the first scientist to give the commencement speech.
Oprah Winfrey was their first speaker and the second was Michelle Obama, so the two before me were really impressive.
Looking over those young women, it was clear to me that we needed more women in research and health care and that those women are the future leaders in science. That was something I was really proud of.
What do high-school students do at the Oncofertility Saturday Academy do?
We started it to provide a line of opportunity for Chicago Public School students, particularly young women, to basically see themselves as potential participants in health care or research.
When you are in high school you don’t really know what the opportunities are even if have a subtle interest in science. We are providing the opportunity to see real live scientists, doctors and nurses at work.
We have a total of 32 students every year. There are 16 in the junior oncofertility program and 16 in the senior Oncofertility Saturday Academy, plus over 100 faculty and staff that are involved.
The junior program is geared towards learning basic science and really trying to understand the fundamentals of reproductive biology. The senior program applies the basic science, and students have the chance to be a doctor for the day.
What advice do you give to girls who might want to get involved in advanced sciences at the high school level, but do not have access to a program like the Saturday academy?
We have a lot of people who really want to come into this program from all over the world. What I tell them is to go and find someone at their school and be persistent. Email them for the opportunity.
I try to encourage faculty to start their own programs. In fact we have started programs around the nation. One in San Diego, Colorado, Oregon and, of course, in Chicago.
We have been able to build this curriculum and share it. Now we are trying to build our curriculum to work with the curriculum of Chicago Public Schools.