Helen Groarke and Dr Lucia Hartigan provide a progress update on our Childhood Cancer Fertility Project for Childhood Cancer Awareness Month
Helen Groarke is a senior Fertility Nurse Specialist and the liaison nurse between CHI (Crumlin) and Merrion Fertility Clinic.
Dr Lucia Hartigan is a Consultant Obstetrician and Gynaecologist at Merrion Fertility Clinic and the National Maternity Hospital and a Clinical Lead for the Childhood Cancer Fertility Project.
The Childhood Cancer Fertility Project was set up to provide fertility care and advice to young people with cancer. Since the launch of this project, Merrion Fertility Clinic has seen 12 boys and 5 girls who have been referred by Children’s Health Ireland (CHI) at Crumlin. Many of these young people now have sperm or eggs frozen in storage at the clinic.
When a young person is diagnosed with cancer, there is a lot to consider. Some, but not all, patients with cancer may develop fertility problems in later life and it is reassuring to know that, freezing of sperm or eggs gives these young persons the opportunity to preserve their fertility for the future. We work very closely with CHI at Crumlin and can see patients as early as is required. There is no waiting list for either boys or girls who need fertility preservation prior to commencing chemotherapy or radiation.
Before the Irish Cancer Society funded this service, we did a small pilot study with CHI Crumlin of young women who had received high risk cancer treatment as children, meaning that their treatment had a strong risk of damaging their fertility. We found that, out of 13 young survivors, only two remembered fertility being discussed with them around the time of their treatment. Thanks to the work done by staff at CHI and Merrion Fertility Clinic for the Childhood Cancer Fertility Project, young people diagnosed with cancer and their parents are now having these important discussions and they can be easily referred to our fertility specialists.
Fertility preservation - What's involved
In the case of the boys, the team looking after an adolescent boy in CHI at Crumlin will make a referral to Merrion Fertility Clinic, having discussed the option of fertility preservation with him and his parents. For an adolescent boy, once he has gone through puberty and can produce a sample, the process is relatively non-invasive, but he needs to be well enough to go through the process. If he wishes to proceed, he can attend Merrion Fertility Clinic with his parents(s) at a time that suits all involved. If a sample is produced, and there is sperm in the sample, it is then frozen (cryopreserved) and the family is informed, as are his doctors in Crumlin. In certain situations, the young boy can produce a sample in CHI at Crumlin, where the fertility nurse from MFC will meet him and his family.
The process of egg freezing for adolescent girls is much more involved than for the boys. Briefly, this requires 2 weeks of self-administering hormone injections to mature multiple eggs or oocytes in the ovaries. The girl will have 3-4 ultrasound scans over this time, to see how the eggs are growing. Once they are of the optimal size, the girl will have a procedure under sedation to retrieve the eggs. Mature eggs will then be frozen and stored. In the future, when she wants to get pregnant, the eggs can be thawed and used in an IVF cycle.
Sperm freezing has been around for over 40 years now. Sperm itself is very resilient and can be stored indefinitely, as long as it is kept frozen in liquid nitrogen.
Egg freezing has improved greatly in recent years, but it is still a relatively new technique. While there is still no long term data on egg freezing, literature is reassuring.
How the project has been received by patients and their families
We have found that parents in particular are very grateful for the opportunity to ensure that their child’s future fertility is protected. The feedback has been extremely positive. While these can be uncomfortable or embarrassing conversations to have, particularly for the young boys, families have told us they feel that their child has been treated by staff in an age appropriate way. Overall, they are relieved that they can look forward to a future beyond cancer.
We had a parent who called after their son had completed treatment. They wanted to let us know that once their son had discussed and gone through the process of fertility preservation, his attitude completely changed toward his cancer treatment, because it gave him hope.
That’s what this project is about, reassurance and hope for our young patients and their families.
Advice for young people concerned about their fertility
Most survivors of childhood cancer can be assured that their fertility is unlikely to have been affected. Unfortunately however, some young women who were treated with certain types of chemotherapy or radiotherapy may be at risk of reaching menopause early.
As this risk increases with time there may still be an opportunity to preserve their fertility (eggs) in their twenties. As part of the Childhood Cancer Fertility Project, we can check the fertility of young female survivors (17-24 years) and arrange egg freezing, if necessary. Thanks to the Irish Cancer Society, all of this is free of charge to these young women. So we encourage any young women with concerns to make an appointment to see us at Merrion Fertility Clinic.
Because sperm counts in boys/men do not decrease with time as eggs do, this service is not necessary for boys/young men. However, if you are particularly concerned, talk to your GP and we can see you if they feel you need a referral.
Goals for next two years
Our major goal is to establish a fertility preservation service for young, pre-pubertal cancer patients. Rather than freezing eggs or sperm, fertility preservation in very young children requires that we freeze biopsies from the ovaries or testes, a process called gonadal tissue cryopreservation. Up to now, this has not been available at all to young patients here in Ireland. Later this month, two of our doctors and our lab manager will make a site visit to several state-of-the-art tissue cryopreservation units in the U.K., including the Fertility Trust in Oxford. The plan is then to implement the same setup here, so that children with cancer can have the same opportunity to preserve their future fertility. This is standard of care throughout Europe – we feel very strongly that young patients in Ireland deserve the same.