Preserving The Fertility Of Young Chemo Patients

Six-year-old Mylah Bryant has a blood disease (aplastic anemia) that required chemotherapy and a bone marrow transplant at Cincinnati Children’s Hospital Medical Center.

Not only did doctors discuss making her well, they asked her parents if they wanted to preserve tissue so she could reproduce years later without the damaging effects of chemotherapy.

It was a lot to think about, according to Mylah’s dad Matthew, but because his daughter jokingly said “she wanted 1,000 children,” he knew being a mother was important to her. This decision was on top of other decisions he and his wife needed to make.

“A lot of paperwork signing. You do the consents and somebody says ‘hey what do you think about taking out your daughter’s ovary?’ Um, ok, and so we kind of left it at that. There’s a lot of information, a lot of it is a blur.”

It was Children’s Fertility Navigator Olivia Frias who introduced the idea to the Bryants and explained the specifics. She sees about seven to ten new patients a week. She says, “Of course there’s so many emotions, a malignancy or maybe they have found some type of blood disorder that’s going to warrant them a BMT (bone marrow transplant). But at the end of the day parents are very enlightened when they hear about this information and they are thankful about hearing about this.”

The Children’s Comprehensive Fertility Care and Preservation program team has been together since 2009 and today only a handful of hospitals offer it. Dr. Lesley Breech is director of the division of gynecology.

“Our philosophy is that every new patient to our cancer and blood disorders institute have a fertility consult and we would meet with them and talk about the options for that age patient or if the patient is after puberty or before puberty… all those implications about what choices would be available for the patient or the family.”

Breech says no patient is really too young or too old. Deciding to remove ovarian or testicular tissue or eggs or sperm depends on how great the risk from chemotherapy and radiation will be.

The Options:

  • pubertal boys: sperm banking.
  • pubertal girls: egg freezing.
  • pre-pubertal boys: testicular preservation.
  • pre-pubertal girls: ovarian tissue cryo-preservation.

The removal and processing is not cheap. At the hospital it can range from $5,000 to $15,000. Storage at places like Reprotech is $200 to $400  a year. But Dr. Breech says there are charitable organizations that help with the cost.

Since 2012, Children’s has performed 40 such procedures. The families who choose to do it must agree to donate 20 percent of the material to research. They keep 80 percent. Frias explains, “So that 20 percent is going off to the research world and what does that mean for the parents? Are there going to be babies running around with their child’s DNA? That can always be a concern and we do our best to reassure them that is not the case at all. This is strictly for research purposes.”

The material is stored at Reprotech until the patient wants to become pregnant.

Fertility preservation is still experimental but doctors in Belgium report this year the first live birth by a 27-year-old woman who had ovarian tissue preserved when she was 13 before getting chemotherapy for a bone marrow transplant.