If you have just been diagnosed with cancer, having a baby may be the last thing on your mind. But cancer is not the death sentence it used to be. Powerful new anti-cancer drugs, chemotherapy and radiation treatments are saving more lives every day.

Gary D. Smith Photo: Martin Vloet

Unfortunately, the same cancer treatments which save lives can also cause infertility and destroy dreams of becoming a parent forever. So cancer patients must consider this very personal decision carefully, before beginning therapy. Too often, in the shock and worry that follow a diagnosis of cancer — especially in a child or adolescent — the issue of infertility is overlooked or avoided, says Gary D. Smith, Ph.D., a U-M associate professor of obstetrics/gynecology who directs the new U-M Fertility Counseling and Gamete Cryopreservation Program.

“With increasing success in curing cancers, issues pertaining to quality of life after cancer treatment become more relevant,” Smith says. “For many people, becoming a parent is one of the most important things in life.”

Marcia Leonard Photo: Gregory Fox

Supported by the U-M Comprehensive Cancer Center, the U-M Department of Obstetrics and Gynecology and the U-M Assisted Reproductive Technologies Laboratory, the program was developed to provide accurate information and help U-M patients and their families handle the complex legal, technical and personal issues involved in fertility preservation and cancer.

Because cryopreservation technologies used to freeze eggs and ovarian tissue are still experimental, the U-M program currently accepts only semen and sperm-producing cells found in testicular tissue.

“It all comes down to the size of the cell and what you expect it to do following thaw,” Smith explains. “Sperm are easy to preserve, because they are small and their primary function is to contribute genetic material. Eggs are large with multiple components and complex functions. When eggs are frozen, ice crystals form inside causing intracellular damage which compromises the egg’s viability and/or ability to support the many tasks required for normal embryo development.”

Marcia Leonard, R.N., is the nurse-practitioner who counsels men and boys referred to the Gamete Cryopreservation Program by U-M physicians. “People don’t understand how complicated it is,” says Leonard. “They just want to know if they will be infertile after treatment, but in most cases the data are too incomplete to predict an individual outcome. The incidence of sterility varies widely depending on the location of the cancer, the patient’s age, the fertility level before cancer, and the type, amount and intensity of treatment.” One of the most difficult and sensitive parts of her job is counseling teen-age boys who must deal with issues involving sexuality and reproduction before they have the emotional maturity to handle them.

In addition to counseling, one of the most important areas of the new program is its emphasis on research. Smith and other scientists affiliated with the program are currently working to evaluate new technologies that could improve a woman’s chances of preserving eggs or ovarian tissue that would be viable years later when they are thawed. A “flash-freeze” technique called vitrification, which eliminates ice crystal formation, shows a great deal of promise, according to Smith.

“Some laboratories will freeze eggs now on the assumption they will figure out how to maintain viability later,” Smith says. “But there’s a fine line between reality and hype. We hope to be able to offer the service to women soon, with a realistic expectation of success.”

—SFP

Information on the program