Family Matters

Even as Babies, Cancer Patients Strive to Preserve Fertility

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Tina Robison, a gynecologic oncologist, sends all her patients of child-bearing age for counseling about ways to safeguard their fertility after they’ve been handed a cancer diagnosis. So when she and her husband, who is also a physician, learned that their own baby daughter had the rare muscle cancer rhabdomyosarcoma, they knew to ask how the treatment would affect her ability to have children one day.

It was strange to think about Izzy — who was just a child herself — having children, but such is the nature of cancer. It makes you think about things you’d never previously considered.

Izzy, now 2½, had part of her left ovary frozen last year by doctors at Hasbro Children’s Hospital and Women & Infants Hospital of Rhode Island, where her parents work. When she is ready to have children, the tissue would be transplanted, where it would start releasing eggs as a normal ovary does. (More on First Comes Cancer, Then Come Children: The New World of Oncofertility)

The hospitals, which are affiliated with Brown University, are part of a group of just 10 U.S. centers that have approval to perform fertility preservation techniques in children. The centers are part of the nationwide Oncofertility Consortium, a group of some 60 institutions that aims to integrate fertility preservation with cancer diagnoses.

The surgery was done when Izzy was 17 months old, making her what appears to be the youngest girl to have had this procedure. Earlier this month, a family from the Cleveland area brought their 2-year-old daughter, who has a stage four neuroblastoma, to Rhode Island for the same procedure. Oncologists in Ohio had told the family that there were no options for fertility preservation in such a young child.

“We very much believe parents should be aware of this as an option,” says Robison. “If you miss that opportunity, it’s not something you can go back for.” (More on Time.comKids, Cancer and Clinical Trials: Parents Are Confused)

Cryopreserving, or freezing, ovaries is not just for children. Several months ago, I wrote about fertility preservation options for women in their child-bearing years who are socked with a cancer diagnosis. (Men have a less-technical and far easier option: freezing sperm; young boys can participate in studies that freeze stem cells from their testes that will eventually yield sperm.)

In both women and girls, however, ovarian cryopreservation is considered experimental. Babies have been born from frozen ovarian tissue, but it’s not known how long an ovary can be frozen. Will a child’s ovary — the size of a lima bean — freeze, thaw and reimplant like an adult’s, which is a little bigger than a walnut? Young girls whose ovaries are harvested now won’t need that tissue for at least 20 years; whether it will still be viable then is anyone’s guess.

Some critics have raised questions about putting children through surgery for just the possibility of potential offspring. “We know we’re taking a leap of faith,” says Kyle Wohlrab, Izzy’s father. He and Robison remain hopeful that medical technology will only improve in the coming decades.

With estimates that 1 in 500 children will receive a cancer diagnosis, doctors and scientists are working on offering more choices to affected families. More than 15,000 of the 1.5 million cancer diagnoses delivered last year were to kids under 20. But cure rates are high — 80% for pediatric cancers that are treated aggressively — and parents are increasingly concerned about giving their children a chance to have their own kids once they’re grown. (More on Time.comAfter Single Ovarian Transplant, Woman Gives Birth Twice)

“There’s been a dramatic increase in survivors,” says Jared Robins, director of the fertility preservation program at Brown’s
Alpert Medical School. “Most of the focus has been on what we can do to help you survive, and now it has to be about how we can help you live.”

The techniques may be experimental, but Robins believes they will work. “It certainly gives hope to these parents and children, and hope is such a powerful therapy in itself.”