Stay Informed

"You have cancer."
"Your wife has cancer."
"Your daughter has cancer."
The words are chilling. Even terrifying. They trigger such terror, it's hard to hear anything that comes after the word "cancer." It can feel as though the word itself eclipses everything else, and that the diagnosis is synonymous with imminent death. And yet, medical researchers and clinicians have teamed up to make an increasing number of cancers survivable, even curable. So as more and more adolescent girls and women survive—and even thrive—after receiving cancer diagnoses and treatments, their hopes and dreams are increasingly turning to the quality of their post-cancer lives, including fertility and having children.

When "Annika" was diagnosed with Hodgkin's lymphoma at age 25, in 1997, survival was foremost in her mind. Luckily, her hometown of Brussels, Belgium hosts a pioneering clinic that has been on the forefront of fertility preservation in cancer patients for nearly 20 years. Recently, a team of doctors from Brigham and Women’s Hospital (BWH) travelled to Brussels to gain the expertise they'll need to establish a similar program at BWH, in partnership with Children’s Hospital and the Dana-Farber Cancer Institute.

At the Catholic University of Louvain, in Brussels, Belgium, Dr. Jacques Donnez leads a devoted team of clinicians and scientists who are pioneering ovarian tissue cryopreservation. In 1997, before Annika began her cancer treatments, Dr. Donnez’s team removed some of her healthy ovarian tissue and froze it for long-term storage. By the time her chemotherapy treatments were completed, she was infertile.

In 2003, Dr. Donnez’s team successfully reimplanted Annika’s cryopreserved ovarian tissue that they had removed six years earlier. Five months later she began ovulating again, and eleven months after reimplantation she became pregnant via natural fertilization. In 2004, she became the first woman in the world to give birth to a healthy baby after reimplantation of her own cryopreserved ovarian tissue.

Dr. Catherine Racowsky, director of the assisted reproductive technologies laboratory at BWH and Professor at Harvard Medical School, envisions achieving similar medical milestones here at BWH. On their recent trip to visit Dr. Donnez’s clinic, the BWH team observed ovarian tissue harvesting and re-implantation procedures, and learned and practiced laboratory protocols alongside Dr. Donnez’s team for freezing and thawing ovarian tissue, and isolating follicles from this tissue for growth in the laboratory. Reflecting on the trip, Dr. Racowsky said, “We are committed to establishing Brigham and Women’s as the premier site for fertility preservation in our country. In order to achieve this mission, we felt it was crucial to visit the world’s most successful ovarian tissue cryopreservation group given the novel nature of these procedures.

In addition to Dr. Racowsky, the BWH team that travelled to Belgium included Dr. Elizabeth Ginsburg, medical director of assisted reproductive technologies at BWH and Associate Professor at Harvard Medical School; Dr. Antonio Gargiulo, director of robotic reproductive surgery at BWH and Assistant Professor at Harvard Medical School; and Dr. Sara Barton, clinical fellow in reproductive endocrinology at BWH.

Philanthropic support for a BWH fertility preservation center could help restore the hopes and dreams of girls and women coping with cancer diagnoses. To learn more about bringing fertility preservation to BWH, contact Kim Lubin in the BWH Development Office at klubin@partners.org or at 617-424-4223.

• Get tested for Rubella (German Measles)
Rubella is a virus that causes a mild disease consisting of rash and fever in most children who are infected. Significant birth defects can occur if a pregnant woman who has not had the disease or been vaccinated against it is exposed to the rubella virus.

• Take Folic Acid (Folate) Supplements
To help avoid major birth defects you should take a multivitamin with 400 mgs of folic acid every day. This is the dose in most regular one-a-day type vitamins and prenatal vitamins.

• Consider HIV testing
The US Public Health Service recommends that every pregnant woman undergo testing for HIV. If an infection is uncovered there is effective treatment to decrease the chance of passing this virus on to your child.

• Stop Smoking
Evidence shows that smokers, both male and female, seem to have more difficulty establishing a pregnancy.

• Embryo Freezing and Cryo Embryo Transfer Cycles (CET)
Extra embryos that appear to be of sufficient quality to survive the freezing process are frozen if the couple wishes to take advantage of this technology and are stored for future use in a CET cycle.

• Relieve Stress
There is evidence that couples experiencing infertility can be under significant stress. This can be harmful to your work, your relationships and perhaps your ability to conceive. There are many options to help you decrease the stress you feel.

• Decisions about Fertility Treatments
BWH is here to work with you to find the best available treatment for you and your partner. Not everyone is eligible for all treatments, and even the most effective treatments will not work for everyone.

• Genetic Counseling
Certain couples may be at risk for genetic problems in their babies. If there is a history in your family or your partner's family of babies with significant birth defects, or a history of multiple miscarriages, please let your medical team know so they can explore the possibilities..

• IUI (Intrauterine Insemination)
The male partner's sperm is collected and is then injected into the female partner's cervix usually on two consecutive days at the time of ovulation. An oral medication, Clomid, is often taken on days five to nine increasing the success rate of this treatment.

• IVF (In Vitro Fertilization)
Oocytes are retrieved from the patient and inseminated 4-6 hours later with sperm. After 16-20 hours, the oocytes are examined to see if fertilization has occurred. If it has, the embryo is cultured and selected embryos are transferred to the patient's uterus during an embryo transfer.

• GIFT (Gamete Intrafallopian Transfer)
Eggs are retrieved from the patient and placed into drops of freshly prepared sperm. The eggs and sperm are then loaded from these drops into a sterile catheter that is used to transfer the cells into the Fallopian tube while the patient is under anesthesia. Although no embryo transfer takes place, extra eggs may be placed into culture with sperm to try to obtain embryos for freezing (if good quality embryos develop).

• Micromanipulaton Technologies
- Intracytoplasmic sperm injection (ICSI)
ICSI is performed in cases where the number of sperm available is extremely low or there is a past history of failed fertilization. Here, a single sperm is injected directly into the egg, "artificially" fertilizing the egg.
- Assisted hatching (AH)
AH involves creating a hole in the covering around the embryo, known as the zona pellucida. This procedure is offered to older patients, those with repeat failed implantations and/or those whose zonae appear thicker than normal. It is thought that by creating a hole in the zona, escapement from the covering is enhanced, and the normal hatching process from the covering is facilitated.
- Preimplantation genetic diagnosis (PGD)
The PGD procedure is offered to those couples at risk for having eggs with an abnormal number of chromosomes, or who have documented chromosome or single gene defects. Currently, we offer screening for 8 chromosomes, for traceable genetic translocations and for certain single gene defects such as cystic fibrosis, osteporosis and Tay- Sachs.

• Surgical Sperm Extraction
In some instances (i.e. failed vasectomy reversal or congenital absence of the vas deferens) it may be necessary surgically to recover sperm from the testes. Very often, we are able to freeze these sperm extractions for future use in IVF/ICSI cycles.

• Donor Oocyte
Ovum Donation provides many couples previously considered "incurably infertile" the chance for a pregnancy. Designated and anonymous egg donation is available. Donors undergo standard IVF treatment using the recipient partner's sperm and the resulting embryos are transferred into the recipient after her uterus is prepared using hormonal therapy similar to that given the CET patients.

• Gestational Carriers
The use of a gestational carrier may be offered to patients with physical disorders that preclude them from becoming pregnant. The patient may choose to bring her own carrier, or, we can provide matching service options. The age limit for gestational carriers is 40. Patients who choose this treatment option undergo standard IVF treatment and the resulting embryos are transferred into the recipient after her uterus is prepared using hormonal therapy similar to that given the CET patients.