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Specific types of chemotherapy and radiation treatments can destroy the ovarian follicles (ovarian follicles mature and support an egg until ovulation) and predispose a female to premature menopause and infertility. Another way to think of it is that chemotherapy or radiation can take you from having the ovaries of, say, a twenty nine year old and make you have the ovaries of a forty two year old. Each treatment is going to affect a patient differently, and [this] depends on many factors. It's important for each patient to have a tailored approach to fertility preservation so her best interests are kept in mind.

A. Teresa Woodruff's lab (chief of the Division of Fertility Preservation) is working on in vitro maturation. We take one of those cortical strips, thaw it, and isolate the primordial follicle. That follicle gets put into a 3D alginate (a gelatinous substance extracted from the walls of some types of algae) system, so that the egg can grow and mature within that 3D alginate sphere. The hope is that we would then get a mature egg, which we could mix with sperm in vitro to create an embryo, and then transfer that embryo into the female's uterus. That has been successful in mice. We're working now on non human primates, but we not sure when we'll be ready for humans.

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As a patient navigator at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Kristin Smith guides newly diagnosed cancer patients through a hopeful process preserving their future ability to have children in the face of life saving, fertility threatening treatments. Science in Society spoke with Babyliss Curl Pro

A. When I meet with someone, we talk about her cancer, the treatment she will likely get, and how damaging it might be to her fertility. And by that I mean how damaging it will be to her ovarian reserve, or the amount of eggs in [her] ovaries.

A. There are three options a woman has to remove her eggs from her body before she receives treatment that will negatively impact her fertility.

A. The other option is ovarian tissue freezing. Here at Northwestern, we've had around 25 cases of tissue freezing. A good example of a patient who would undergo tissue freezing is someone who has just been diagnosed with a type of very aggressive cancer and the chemotherapy they're going to get will most likely deplete their ovarian reserve.

The biggest drawback to egg and embryo freezing is the time it takes to undergo this process. Often times, it takes two to three weeks for a patient to go through a stimulation and retrieval. Sometimes this time window isn't an option for a patient who needs to begin treatment immediately.

documented pregnancies resulting from this type of technology. However, we don't know the denominator to those successes, so we can't put a number on how often this type of procedure results in a live birth.

Men have somewhat of an advantage, because they're constantly producing sperm. As a female, we're born with all of the eggs we're ever going to have, and we have no way to make new eggs. A female's fertility is dependent on how many eggs she has in her ovaries and the quality Chi Flat Iron Official Website of those eggs. Generally, a female is in her peak fertility in her late teens to early 20s. As a female ages, the ovarian reserve naturally declines until the female becomes naturally infertile, [in her] late 40s to early 50s.

Q. Are there options for patients who don't have this time window?

Smith about her unique position, what fertility preservation options are currently available for women, and the exciting prospects that lie ahead.

Once our embryology lab gets these eggs, they can do one of two things. They can either freeze the eggs or mix the eggs with sperm and create embryos (in vitro fertilization), and then freeze the embryos. Embryo freezing is something that's been done at Northwestern for 20+ years it's something that we're very comfortable with. We have great success rates with it.

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Q. How do you start developing a fertility preservation plan for a patient?

Egg freezing is relatively new, and the American Society of Reproductive Medicine (ASRM) has stipulated that egg freezing still be considered experimental. The reason that it's more difficult is because an egg is a little more delicate than an embryo. An egg is one cell, it's full of water, and during some freezing procedures, if they're not done correctly, ice crystals can form within the egg and destroy it. We use a process here at Northwestern called vitrification, which is a flash freezing process, and it has higher success rates of subsequent thaw and fertilization compared to a slow freeze, which is how most centers cryopreserve embryos.

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For some patients, like a leukemia patient, you wouldn't be able to do this because ovarian tissue is leukocyte rich, and there's a chance you could reseed that patient with her cancer. So there's only a small handful of patients for whom that transplant of tissue would be something her physician would be comfortable with.

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embryo freezing. These are fairly similar in terms of [what] goes into it up front. We time the start of it with her menstrual cycle. The female will inject herself with fertility medications, which tell her ovaries to recruit and mature multiple eggs instead of one egg. It could be anywhere between five to twenty eggs. As she's maturing these eggs, a reproductive endocrinologist (REI) is continuously monitoring her with trans vaginal ultrasounds and blood work to measure estrogen levels. This monitoring ensures that the patient is safely stimulating her ovaries. When she gets to a specific point in the stimulation, the REI will perform an egg retrieval in an outpatient setting.

Q. Are there other options being researched at Northwestern?

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For ovarian tissue freezing, an entire ovary is surgically removed from a patient. This surgery is done as an outpatient procedure, and is usually done laparoscopically. Once the ovary is removed, scientists in a lab remove the outer edge of the ovary, the cortex. The cortex is where all of the primordial follicles the very young and immature follicles are located. Scientists cut the outer edge into cortical strips and then freeze those strips. The hope is that, in the future when the female is ready to attempt a pregnancy, you could take a portion of those strips, thaw them, sew them back together to look almost like a quilt, and then transplant that tissue back into the vascular bed where the ovary used to sit.

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Q. What options are currently available?

Navigating Fertility After Cancer

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