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Dr. Humberto ScocciaA diagnosis of cancer in a woman used to mean she often couldn’t have kids. “Women would go through treatment without any fertility advice or options,” says Northwestern’s Woodruff. But today oncofertility is an active area of research in Chicago. The National Institutes of Health (NIH) has funded a large oncofertility consortium, led by Northwestern University, with the goal of using an interdisciplinary team to try to solve complex problems related to fertility and cancer treatments. (For more information, see myonco fertility.org.) Today most women with cancer can go through in-vitro fertilization (IVF) to create an embryo—a fertilized egg—to freeze. (The national percentage of cases of frozen embryos resulting in live births is 35.6 percent for women under 35 and 29.5 percent for women 35 to 37, according to the Society for Assisted Reproductive Technologies, the trade group for fertility doctors.)
The advances in IVF techniques have led to some curious situations. Two years ago, when she was 39, Noelle Freeland, a mortgage broker, learned she had a rapidly growing cancer in her left ovary. In just four weeks, the cancer increased from half a centimeter to 13 centimeters, wrapping around the back of her uterus and attaching itself to her pelvis. She wanted to preserve her ability to give birth, but her cancer was estrogen-positive, which meant fertility drugs could accelerate the disease. Her doctor at Northwestern told Freeland that he would allow her to do only one cycle of IVF.
At the time, only 3 percent of frozen eggs that were later fertilized resulted in live births, and the success rate with frozen embryos for women of Freeland’s age was 26 percent—statistics that affected her decision. She took the fertility drug, underwent one IVF cycle, and was able to freeze four embryos fertilized using sperm donated by a friend’s husband. “I had 48 hours to decide who I wanted to be the father of my children,” she says.
For about 20 percent of patients (those who are too young or whose cancer is too advanced), the IVF option is not available. Northwestern researchers—led by Woodruff—are trying another approach. Girls are born with ovaries that contain about a million follicles, each with a single egg inside. By age 20, half a million are left, sitting in a dormant state; by menopause, they are all gone. Normally, one egg matures inside the ovary each month. But chemotherapy and radiation can damage eggs and lead to infertility. To preserve the option of pregnancy, the Northwestern team is trying to remove healthy ovaries before treatment starts, isolate immature follicles, and mature the enclosed eggs. The hope is to have this technology available for patients after their recovery from cancer treatment.
Noelle Freeland donated her good ovary to Woodruff’s group to work on growing more follicles. “It’s not going to work for me, but it’s going to work for other people,” Freeland says. “I didn’t need that organ.”
Many cancer-free women who can’t easily get pregnant worry that infertility treatments could increase their risk of ovarian cancer. (The actress Gilda Radner speculated that fertility drugs may have caused her to get the disease.) But Humberto Scoccia, the director of reproductive endocrinology and infertility at the University of Illinois Medical Center, says there’s no evidence of a link. “We have not seen any increased risk in breast, ovarian, or uterine cancer,” he says. To find out more definitely, the NIH has just started a 30-year follow-up of 12,000 women who went through infertility treatment.
HEART DISEASE | FERTILITY | PREGNANCY | BREAST AND OVARIAN CANCER
CERVICAL AND ENDOMETRIAL CANCER | OSTEOPOROSIS
HEADACHES, MULTIPLE SCLEROSIS, AND OTHER NEUROLOGIC DISORDERS | DEPRESSION
EATING DISORDERS | INCONTINENCE | IMMUNE DISORDERS | SLEEP DISORDERS
Photograph: Taylor Castle Assistant: Ace Ujimori Hair and Makeup: Morgan Blaul