Fertility Preservation and Cancer

Transcript

00:00 --> 00:10Support for Yale Cancer Answers comes from AstraZeneca, providing important treatment options for women living with advanced ovarian cancer.
00:10 --> 00:13Learn more at astrazeneca-us.com.
00:13 --> 00:18Welcome to Yale Cancer Answers with doctors Anees Chagpar and Steven Gore,
00:18 --> 00:28Yale Cancer Answers features the latest information on cancer care by welcoming oncologists and specialists who are on the forefront of the battle to fight cancer. This week
00:28 --> 00:32it's a conversation about fertility preservation with Doctor Pasquale Patrizio.
00:32 --> 00:41Dr. Patrizio is Professor of Obstetrics Gynecology and Reproductive Sciences at Yale School of Medicine and Director of the Yale Fertility Center
00:41 --> 00:52and fertility preservation program.
00:52 --> 00:55Thanks for joining me tonight, before we get started
00:55 --> 00:58can you recite that title by yourself?
00:58 --> 01:04That is the longest title I think I've ever interviewed anybody with.
01:04 --> 01:06Thank you and good evening to everyone.
01:06 --> 01:08Yes. It's a mouthful.
01:08 --> 01:14But simply said, I'm in charge of patients that have a problem in achieving a pregnancy.
01:14 --> 01:16So that's the fertility center.
01:16 --> 01:20And in addition, I also specialize in fertility preservation,
01:20 --> 01:26which is a branch of our subspecialty of Reproductive Medicine,
01:26 --> 01:35which is specifically aimed at patients that have been hit by cancer or any other medical condition,
01:35 --> 01:41or they want to preserve their fertility for future at a future time.
01:41 --> 01:45That's fascinating, so did you come into the field,
01:45 --> 01:53then through a sort of traditional obstetrics and gynecology training or an endocrinology training or a cancer training?
01:53 --> 01:57Yes, in order to be specializing in reproductive medicine,
01:57 --> 02:03you first do a residency in obstetrics and gynecology and then you do additional training,
02:03 --> 02:07specifically in reproductive medicine and infertility.
02:07 --> 02:12And in addition, I also had extra training in two other things.
02:12 --> 02:16I specialized in andrology, which is the study of a male fertility.
02:16 --> 02:19And I also have a master in bioethics,
02:19 --> 02:22so that's my full circle of titles.
02:22 --> 02:26The ethics thing might be a whole different show
02:26 --> 02:30I'm afraid, that would be very fascinating to talk about,
02:30 --> 02:38but I think our listeners are probably interested in the fertility preservation mostly and I have to say,
02:38 --> 02:43of course, with my patients who mostly have leukemia or lymphoma,
02:43 --> 02:47it's often a medical emergency and many of them are young and
02:47 --> 02:49this question of you know,
02:49 --> 02:52should they do fertility preservation?
02:52 --> 02:55Is it feasable how much time do we have?
02:55 --> 03:08These are really pressing questions for us in dealing with our patients and also very important questions and the short answer is yes they should all be at least
03:08 --> 03:12introduced to the concept of fertility preservation.
03:12 --> 03:15When you say young, if they're post pubertal,
03:15 --> 03:21there are options that we will discuss in detail in a little bit,
03:21 --> 03:23but if they are a prepubertal,
03:23 --> 03:29there are also now options for both men and women that they can consider as well.
03:29 --> 03:32It is definitely a discussion that has to be entertained,
03:32 --> 03:37because if it's not entertained, later on after chemotherapy,
03:37 --> 03:42radiotherapy, or any other toxic insult to the reproductive function,
03:42 --> 03:44then there is going to be regret,
03:44 --> 03:48and there is really nothing wrong in having a discussion with a
03:48 --> 04:01reproductive specialist and at the end of the discussion all the options are presented to the patient and if they are young, together with their parents, and they come with
04:01 --> 04:05the issues that can be good for their own specific case.
04:05 --> 04:09Yeah, well, of course my practice is mostly adults,
04:09 --> 04:12and that's what I'm most familiar with.
04:12 --> 04:16And we have patients,
04:16 --> 04:22of course we have some patients in their 30s who have five kids and they've had enough.
04:22 --> 04:29But and then we have the 40 year old that has not yet had a child who are hoping to so it really runs the gamut.
04:29 --> 04:33And you know, I was taught and maybe correct me if I'm wrong,
04:33 --> 04:39I was taught when I was training in leukemia that for the most part when young men,
04:39 --> 04:44young adult men present with either an aggressive lymphoma or leukemia,
04:44 --> 04:50often their sperm count is diminished or their quality of sperm is not very good,
04:50 --> 04:54and at the previous place I was and I'm not sure what the
04:54 --> 04:57rationalization was,
04:57 --> 05:05but they were not routinely order offered semen banking because it was thought well it's not going to be effective anyway.
05:05 --> 05:07Is that old news?
05:07 --> 05:14Definitely old news. You are absolutely correct when you say that men with leukemia and lymphoma,
05:14 --> 05:21during their time that they've been diagnosed
05:21 --> 05:25they do have a decrease in the sperm count,
05:25 --> 05:38but, what is really important is that today's technologies in assisted reproduction are so precise and so effective that even a man with an extremely low sperm count low
05:38 --> 05:45sperm motility, meaning very few swimming that sample still has to be frozen.
05:45 --> 05:54Because we can use a single sperm at the time in an egg and allow virtualization reproduction in that particular case.
05:54 --> 06:01So always always refer and save any sperm that is available in the ejaculate before chemo.
06:01 --> 06:04And of course,
06:04 --> 06:09with many kinds of chemotherapy that we offer younger people,
06:09 --> 06:12they will in fact recover their fertility,
06:12 --> 06:15right? You are also correct here in that,
06:15 --> 06:18particularly with the changes in the
06:18 --> 06:32chemotherapy protocols that are so called the less aggressive towards the testicle are there many cases where the patient recovers and therefore the reproductive function is
06:32 --> 06:35completely saved by the chemotherapy?
06:35 --> 06:41It's impossible to predict who is going to recover and who is not,
06:41 --> 06:45and in particular for men to have a sample cryopreserved it is
06:45 --> 06:47pretty easy. It's easy to do,
06:47 --> 06:50it's much more difficult for a woman.
06:50 --> 06:53Of course, we won't describe it on the radio.
06:53 --> 06:56That's a good idea.
06:56 --> 07:01And therefore it's always good to have at least a sample,
07:01 --> 07:04which can then be split into multiple.
07:04 --> 07:07But at least a sample cryopreserved.
07:07 --> 07:10And if the gentleman recovers,
07:10 --> 07:19great, so that sample can be then disposed of because it costs money every year that the sample is stored,
07:19 --> 07:26right? It does, but it depends on how these expenses are considered.
07:26 --> 07:35If you have to pay $500 or $600 a year to keep a sample frozen and they can be kept frozen for many,
07:35 --> 07:38many years, I mean 15 years 20 years,
07:38 --> 07:41that's not a problem anymore,
07:41 --> 07:43but the moment that you need to use it,
07:43 --> 07:46you don't need to keep it frozen forever.
07:46 --> 07:50And if you don't need to use it
07:50 --> 07:54because your sperm has returned in your ejaculate
07:54 --> 07:55you can throw it out.
07:55 --> 08:00Or if the eggs were frozen and you have recovered your ovarian function.
08:00 --> 08:03For women, they can also dispose of the eggs and in general,
08:03 --> 08:06in my experience, maybe this is outdated,
08:06 --> 08:08but insurance tends not to cover this,
08:08 --> 08:11is that right? This is also an outdated concept and
08:11 --> 08:22I'm glad you ask these questions because we're very proud here in Connecticut to say that we have been the first state in the United States to
08:22 --> 08:29have the service of fertility preservation for cancer or any other medical condition is covered by insurance.
08:29 --> 08:32There is a mandate in Connecticut.
08:32 --> 08:34I've worked here for six years and
08:34 --> 08:36I didn't know that.
08:36 --> 08:38It is true that is now 2 years.
08:38 --> 08:41that bill was signed and we are very,
08:41 --> 08:44very proud that.
08:44 --> 08:48And there are another seven states now that
08:48 --> 08:57are preparing to approve insurance mandate for fertility preservation in cancer conditions in.
08:57 --> 09:00Is that true for the public insurance?
09:00 --> 09:03Like Husky as well for the Medicaid?
09:03 --> 09:08Well, that's of course it's a little bit different for the Husky.
09:08 --> 09:11Those are probably less covered.
09:11 --> 09:13I want to say though,
09:13 --> 09:26that there are programs that we provide and pharmaceutical can provide where medications are given in a compassionate fashion and there are discounts for patients that cannot really afford it
09:26 --> 09:28because of their own specific insurance.
09:28 --> 09:40They are not fully covered and that's really important and ironic really because of course the Husky patients and other subsidized patients are the ones who can least afford the
09:40 --> 09:44out of pocket compared to the well insured
09:44 --> 09:46professional class,
09:50 --> 09:52many of whom have, you know,
09:52 --> 09:56fungible monies.
09:56 --> 10:00And it's very sad to be facing this type of reality.
10:00 --> 10:11However, the fact that there are pharmacies that are offering medications for free and also there are very nice opportunities here.
10:11 --> 10:13At Smilow we have a particular,
10:13 --> 10:16very, very generous station that has
10:16 --> 10:24put together, a fund, particularly for patients that cannot afford, specifically for breast cancer,
10:24 --> 10:27and this is a very thankful patient.
10:27 --> 10:31It's helping others with breast cancer.
10:31 --> 10:33So let's take the case of male patient.
10:33 --> 10:36And let's say it's acute leukemia,
10:36 --> 10:38which is often an emergency.
10:38 --> 10:42And let's say the guy is coming in on a Saturday
10:42 --> 10:45'cause that's what happens or Friday night,
10:45 --> 10:48how fast can we mobilize this really?
10:48 --> 10:50How much time do we have
10:50 --> 10:55for him to give his sample and get it in the freezer before we start chemotherapy.
10:55 --> 11:01Now we are open as a service here seven days a week on.
11:04 --> 11:08So therefore, if we get a phone call,
11:08 --> 11:10we have a 24 hour service.
11:10 --> 11:15We have a phone call that the gentleman has to freeze sperm within 24 hours.
11:15 --> 11:16So this can be done.
11:16 --> 11:18Well, that's great.
11:18 --> 11:25It's a terrific service. Obviously it's more complicated for women because they can't just,
11:25 --> 11:29you know, sit there and fantasize and produce their eggs right?
11:29 --> 11:33I mean, it's a much more complicated procedure,
11:33 --> 11:47so what's involved in how successful is oversight preservation or ovarian preservation for women that need to preserve fertility because of cancer and again before they undergo chemotherapy,
11:47 --> 11:50radiotherapy or any other surgical
11:50 --> 11:54treatment that may impact their future reproductive options.
11:54 --> 12:00The time that we need in order to do a freezing becomes extremely short.
12:00 --> 12:04Two weeks was needed in the old days,
12:04 --> 12:06meaning four or five years ago.
12:06 --> 12:09We need a minimum of four to six weeks.
12:09 --> 12:18That's what I remember and the reason why is the short end is because we learned that we can stimulate ovaries at any part of the menstural cycle.
12:18 --> 12:22So no matter where they are in their cycle
12:22 --> 12:29we can start the stimulation of the ovaries. You used to have to wait until a period so you knew how to time it right.
12:29 --> 12:31But no more.
12:31 --> 12:37We can stimulate the ovaries at any part and in two weeks we can collect eggs.
12:37 --> 12:43It is a process, it's two weeks during which the patient has to be seen three or four times in our office,
12:43 --> 12:53and then they need to take particular medications to stimulate the ovaries in producing more than just one egg and then the collection is also done in the office
12:53 --> 13:01under a heavy sedation and in 15 minutes the eggs are extracted and whatever it is mature is going to be frozen.
13:01 --> 13:04And can I ask how you do the egg harvest?
13:04 --> 13:11Is that through the vagina or through the abdomen with a laparoscope or no it's not surgical.
13:11 --> 13:15It's a mini surgery that is through the vagina.
13:15 --> 13:17There is a vaginal probe ultrasound
13:17 --> 13:24that is fitted with the needle on the end and we give a local anesthesia plus heavy sedation and
13:24 --> 13:28it takes about 15 minutes to harvest through the vagina,
13:28 --> 13:30so there is no cut.
13:30 --> 13:34There is no no bruise and it's a pretty straightforward process to do.
13:34 --> 13:37Well that's a very fascinating process,
13:37 --> 13:40and we're going to want to talk more about it,
13:40 --> 13:45but right now we need to take a short break for medical minute.
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14:41 --> 14:46You're listening to Connecticut public radio.
14:46 --> 14:49Welcome back to Yale Cancer Answers.
14:49 --> 14:51This is doctor Steven Gore.
14:51 --> 14:55I'm joined tonight by my guest doctor Pasquale Patrizio.
14:55 --> 14:58We were discussing fertility preservation and cancer.
14:58 --> 15:10Pasquale, you were telling me before the break that it takes about 2 weeks to stimulate egg production sufficient to harvest in kind of a
15:10 --> 15:14needle aspiration it sounds like to get these eggs.
15:14 --> 15:17What happens to the eggs then?
15:17 --> 15:19Once the eggs are harvested,
15:19 --> 15:22they are assessed in the Embryology lab for maturity.
15:22 --> 15:27We only freeze eggs that are considered mature and generally about 80%
15:27 --> 15:30of the eggs that are harvested
15:30 --> 15:42are considered mature, and then they're going to be frozen and the process of a freezing is also important to let the audience know that has improved dramatically over
15:42 --> 15:44the last seven or eight years,
15:44 --> 15:47with the technique that is called vitrification,
15:47 --> 16:00or very fast freezing and this has been accompanied by an extremely high success in terms of survival rate when the eggs are needed to used.
16:00 --> 16:05And how many on average eggs are attained?
16:05 --> 16:10It depends on the age of the patient,
16:10 --> 16:14the younger, the more we get and over the age of 37 we get fewer,
16:14 --> 16:18but an average women that is younger than 37
16:18 --> 16:25after one cycle day we are able to freeze 10 to 12 eggs. In women that are older than 37.
16:25 --> 16:35in general, we can get 6 eggs as an average.
16:35 --> 16:38Does this treatment in any way impact a patient's future ability to produce eggs if she recovers fertility after chemotherapy?
16:38 --> 16:47This is an excellent question because we are asked all the time whether there is an impact on the future chance over reproduction.
16:47 --> 16:49If we harvest eggs, the answer is no.
16:49 --> 16:57The eggs that are harvested in a particular cycle are eggs that would have been lost anyway,
16:57 --> 17:02so there is no shortening or anticipation of the time to menopause.
17:02 --> 17:12Menopause is going to be decided according to what type of chemotherapy and treatment a patient is going to receive,
17:12 --> 17:19but it is certainly not the egg harvesting that is going to create damage or future risk.
17:19 --> 17:24For fertility, it's important to say.
17:24 --> 17:29You said the success rate of the freezing and thawing has improved.
17:29 --> 17:37So what is the likelihood of being able to create a viable embryo when these eggs are thawed in the future?
17:37 --> 17:47Now it is also important to stress that the great majority of eggs that have been frozen in a cancer patient are still frozen,
17:47 --> 17:53and if we look also at the worldwide experience on how many eggs have been utilized,
17:58 --> 18:00There are not too many cases reported,
18:00 --> 18:05but in general based on the data of the literature,
18:05 --> 18:12we can say that the survival rate of these eggs that have been vitrified is around 80 to 85%.
18:12 --> 18:15So that's very good. They survive.
18:15 --> 18:18They have a very high chance of fertilization.
18:18 --> 18:25About 70%. They can create embryos and once you create at least two good quality embryos,
18:25 --> 18:28the chance of having a baby
18:28 --> 18:32is about 35%, so it's not a slam dunk success,
18:32 --> 18:34but if it's only 35%
18:34 --> 18:37depending how many eggs you start with,
18:37 --> 18:40for having two embryos.
18:40 --> 18:47If you have four embryos that means you have a couple of opportunities for pregnancy,
18:47 --> 18:53then cumulatively you are looking at around 50 to 60%.
18:53 --> 18:58Of course we would always like to have 100%.
18:58 --> 19:02But if
19:02 --> 19:06unfortunately there was no time to do anything or no desire to do anything
19:06 --> 19:08and then you have a regrets,
19:08 --> 19:09then you have 0% right?
19:09 --> 19:17What about the patient? Let's take the female version of the patient that I was describing who comes on a Saturday and really can't wait more than a day or two
19:17 --> 19:19so she's not going to have
19:19 --> 19:2114 days.
19:21 --> 19:24We're going to have to treat her into remission.
19:24 --> 19:28Is it worthwhile to once she's in remission and now she has some time?
19:28 --> 19:30Can you try to harvest eggs then?
19:30 --> 19:38This is a question that gives me the opportunity to elaborate a little bit more on a specific case that you are thinking of,
19:38 --> 19:40which is a leukemia in general.
19:40 --> 19:44They're very sick patients. They have high fever.
19:44 --> 19:47They don't have
19:47 --> 19:51the two weeks of time to wait for having the ovary stimulated.
19:51 --> 20:00So in those cases unfortunately the only option we have at the moment is to take care of their health first and
20:00 --> 20:05use a particular medication that is considered to be protective on the ovary.
20:05 --> 20:12On the ovarian function which is a monthly injection during the time that the patient will undergo chemotherapy,
20:12 --> 20:14but then after a couple of cycles,
20:14 --> 20:17two or three cycles of chemotherapy,
20:17 --> 20:23and if we have an opportunity to wait for about 6 eight weeks before restarting chemotherapy,
20:23 --> 20:26we need 8 weeks before we can then stimulate the ovaries.
20:31 --> 20:38And I cannot stimulate an ovary to collect eggs while the patient is doing chemotherapy.
20:38 --> 20:41Because chemotherapy is extremely toxic for eggs,
20:41 --> 20:44and in those cases eggs are growing.
20:44 --> 20:49Therefore they can be made not viable by the use of the chemotherapy.
20:49 --> 20:51So you need to have a little bit of time,
20:51 --> 21:00but I want to spend also another moment to explain that particularly for leukemia and exclusively for leukemia,
21:00 --> 21:01I should say in this case,
21:01 --> 21:10in the old days there was always a concern that you cannot offer another option which is called ovarian tissue freezing,
21:10 --> 21:21which means you take a piece of ovarian tissue and then you freeze it and we were not offering it because leukemia is one over those cancer that also spreads
21:21 --> 21:32to the ovaries. They don't want to freeze a piece of ovary and then in the future re transplant and risk returning the cancer because the cancer was
21:32 --> 21:35in the already frozen portion
21:35 --> 21:39but today we know that after a couple of cycles of chemotherapy,
21:39 --> 21:45now I can freeze ovarian tissue if there is no time to do ovarian stimulation.
21:45 --> 21:48Because after a couple of cycles of chemotherapy,
21:48 --> 21:52the ovaries have been purged of those leukemic cells that were infiltrating,
21:52 --> 21:55and now you can freeze ovarian tissue,
21:55 --> 21:58and even though the ovaries are still asleep from the drug,
21:58 --> 22:01you can get them from the protected drug.
22:01 --> 22:03They're still going to recover?
22:03 --> 22:10Correct, and three babies have been born and reported 2 from Israel and one from Saint Louis.
22:10 --> 22:14Wow, so you take out the whole ovary or a slice?
22:14 --> 22:18In some cases you can take one ovary,
22:18 --> 22:22leave the other one in place because you never know.
22:25 --> 22:33So if it does not recover then you can use the existing left behind ovary as a scaffold on which you can re graft.
22:33 --> 22:39You can replace that ovarian tissue that had frozen from the ovary that you have removed.
22:39 --> 22:49Well, that's fascinating. So you take the frozen ovarian tissue and you graft it onto the existing ovary that is not functioning anymore and then that will start to function
22:49 --> 22:51again. It takes root, correct?
22:51 --> 22:55And does it usually? I mean probably doesn't happen so often,
22:55 --> 22:59but does it usually recover and service and function?
22:59 --> 23:06So there are a total of close to 200 babies that have been born by doing exactly what we just described.
23:06 --> 23:13And in the United States there are a total of 17 children born by doing a re transplant or grafting ovary on the
23:13 --> 23:18existing ovary that is not functioning anymore or if there is no ovary at all
23:18 --> 23:29those pieces of ovarian tissue that were frozen can be grafted in the pelvic sidewall on the side where it was originally present.
23:29 --> 23:37That's so cool and the patient regains menstrual cycles and things like that after four to five months?
23:37 --> 23:42Yes, because that's the minimum time you need to wait before the ovarian function returns,
23:42 --> 23:45but that's normal also in normal women,
23:45 --> 23:48it takes about four months to produce an egg,
23:48 --> 23:54so they start cycling and therefore the ovarian tissue is making the normal hormones as well.
23:54 --> 23:57The ovary has to make hormones.
23:57 --> 23:59Or do you give them androgynous hormones?
23:59 --> 24:06Now most of the time they produce their own hormone and in fact they are no longer in menopause
24:06 --> 24:10from chemotherapy, they resume their endocrine function as well,
24:10 --> 24:12which means production of estrogen,
24:12 --> 24:15which is one of the main functions of the ovary,
24:15 --> 24:18and occasionally there are reports where you stimulate the ovary,
24:18 --> 24:24ovarian tissue that you re transplanted just to see if you can get two instead of one.
24:24 --> 24:26Maybe you can get two or three eggs,
24:26 --> 24:33but it's remarkable that many of those babies that have been reported they have been achieved by natural cycles,
24:33 --> 24:41and no use of an assistive technique. And where you don't have a graft but you put them
24:41 --> 24:47on the side of the pelvis, do the Fallopian tubes find those?
24:47 --> 24:52No, in this case, you need to harvest and then you do in vitro fertilization.
24:52 --> 24:54I was going to say that's really amazing.
24:54 --> 24:58If the fallopian tubes can find the tissue that would be so cool.
24:58 --> 25:03I mean, that's so interesting and I'm wondering, and I'm going to show my ignorance,
25:03 --> 25:07this is really out of my comfort zone scientifically, but
25:07 --> 25:13why would it not be a good idea to do this kind of ovary in harvest on most pre menopausal women
25:13 --> 25:15who are being treated for cancer?
25:15 --> 25:21Breast cancer patients or something where you don't want estrogen around,
25:21 --> 25:25of course, but people are going to lose their ovarian function predictably,
25:25 --> 25:32and then they're going to have to suffer the consequences of early menopause and bone health and cardiac health and all that stuff.
25:32 --> 25:34Why don't we do this?
25:34 --> 25:38For all of those women and replant them and let them get their tissue back?
25:38 --> 25:43Well again, it's not a stupid question or ignorant question it is a fantastic question,
25:43 --> 25:45and in fact we are working on that.
25:45 --> 25:52I just came back from a meeting where I was talking about exactly what you just asked me,
25:52 --> 26:06and essentially this is a very important future opportunity for not only women with cancer but any other medical condition that can impact early menopause,
26:06 --> 26:11but we're also considering it for women that
26:11 --> 26:16are completely normal and maybe considering it.
26:16 --> 26:21For let's say at age 30-32,
26:21 --> 26:2533 and then when they are approaching menopause at age 48-49,
26:25 --> 26:27because even with one ovary,
26:27 --> 26:36the time to menopause is not different then a woman that has two ovaries and it is a remarkable adaptation of the human body.
26:36 --> 26:39So you take one ovary away.
26:39 --> 26:41Instead of having menopause at age 51,
26:41 --> 26:44for example, you will have it at 48.
26:44 --> 26:46But if you have a frozen
26:46 --> 26:54ovary and you re transplant that issue when the woman is now 48 and you took it when you were 30,
26:54 --> 27:05now you have guaranteed in a way at least another 15 years of endocrine function of estrogen production and that is going to impact in very important ways
27:05 --> 27:11on osteoporosis. Like you mentioned on heart conditions and overall well being for women.
27:11 --> 27:17So we're talking in this case ovarian rejuvenation over postponing menopause.
27:17 --> 27:24And we learned about this from the experience with the conservation in re transplanting ovarian tissue,
27:27 --> 27:35We know how to re transplant ovarian tissue and therefore the question was if we can do it with ovarian tissue in a cancer patient,
27:35 --> 27:37why not to consider it
27:37 --> 27:45in women that want to postpone menopause and don't need to take hormones for a prolonged period of time,
27:45 --> 27:49particularly now that lifespan is increased so much.
27:49 --> 27:52A woman spending an average of over 30 years in menopause.
27:52 --> 27:56So therefore, this is an option that is on the table.
27:56 --> 28:00And even though it's under experimental condition at the moment,
28:00 --> 28:02it's definitely on the table.
28:02 --> 28:10I guess you have to follow women to make sure that the ongoing years of exposure to estrogen from their body turns out not to be harmful.
28:10 --> 28:15There was a lot of scare in the old days about people taking high doses of Premarin,
28:15 --> 28:19and whether that was influencing cancer and so on.
28:19 --> 28:26Back when higher doses of unopposed estrogen were being administered routinely to post menopausal women,
28:26 --> 28:29right? That's correct, but I want to add that today,
28:29 --> 28:32the way that the medical field is moving,
28:32 --> 28:38particularly with the opportunity of doing so much screening for cancer genetic mutations
28:38 --> 28:49if we know background or whether or not the particular patient has a family history and presence of particular cancer mutations and the number of mutations that are available
28:49 --> 28:52for screening is increasing by the day,
28:52 --> 28:54then we can consider two things.
28:55 --> 28:58We can transplant ovarian tissue.
28:58 --> 29:01The ovarian tissue production of a hormone is natural hormone.
29:01 --> 29:08The face of the so called physiological is not the one that has been built or produced.
29:08 --> 29:13and therefore we think it is going to be a little bit better.
29:13 --> 29:19But I totally agree with you, we have to be very cautious and this is not going to be for everyone.
29:19 --> 29:22Well this is fascinating and I think we could
29:22 --> 29:26definitely segue into the ethical discussion if we only had time,
29:26 --> 29:28but in the mean time we are out of time.
29:28 --> 29:34Pasquale, it's great having you here on Yale Cancer Answers and I've totally enjoyed myself.
29:34 --> 29:36It's been a terrific show learning about fertility,
29:36 --> 29:40preservation and cancer, and it's so hopeful for our younger patients.
29:40 --> 29:44And I just think we need to communicate with the oncologist like myself,
29:44 --> 29:52who really are not up to date all the time on how your field has really transformed even in the last few years that I've been here.
29:52 --> 29:56So congratulations and Kudos. And thank you for having this discussion,
29:56 --> 30:05which is extremely important.
30:08 --> 30:14As you said, we need to make sure that our colleague oncologists are aware of the options we have.
30:14 --> 30:18So many options that we can really make the life of these patients much,
30:18 --> 30:27much better for their future. Dr. Pasquale Patrizio is Professor of Obstetrics and Gynecology and Reproductive Sciences at the Yale School of Medicine and
30:27 --> 30:32Director of the Yale Fertility Center and fertility preservation program.
30:32 --> 30:41If you have questions, the address is canceranswers@yale.edu and past editions of the program are available in audio and written form at Yalecancercenter.org.
30:41 --> 30:48We hope you'll join us next week to learn more about the fight against cancer here on Connecticut public radio.

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April 5, 2020

Yale Cancer Center

visit: http://www.yalecancercenter.org

email: canceranswers@yale.edu

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