Top Docs 2016: Future Generations

When a child faces cancer, preserving her fertility could be the last thing on a parent’s mind. But it shouldn’t be.

Lesley Breech, MD, gynecologist
Comprehensive Fertility Care & Preservation Program at Cincinnati Children’s Hospital Medical Center

—As told to Lisa Murtha

“The Comprehensive Fertility Care and Preservation Program is offered for both boys and girls. There are only 19 centers that are currently members [of] The Oncofertility Consortium in the pediatric world—we are one of those 19. To be honest, we are the best.

It’s been a very empowering experience for patients and families. Some literature suggests that one of the areas of disappointment for pediatric cancer patients was that no one discussed fertility with them before their treatment. If you’re diagnosed with breast cancer [as an adult], often you have a few weeks until you see the radiation oncologist; in pediatrics, the cancers are treated more rigorously—somewhere between one to five days until treatment starts. Sperm banking and testicular freezing are [investigational] options available for boys; then we have [also investigational] ovary freezing, embryo freezing, egg freezing, and a medical injection for girls that essentially puts the ovaries into “hibernation” to protect them.

Even in a 2-year-old there are some measures we can look at to see future fertility potential. Some of these interventions may be more invasive than others, so when a parent is trying to make a decision for their child, which holds its own ethical questions, that’s a big decision for them. We have a couple of oncologists [who] serve as our risk assessment team. We use this little spectrum and we kind of plot out where we predict the risk would be, so that patients and families can make a decision that’s appropriate for them.

We’ve done close to 300 consultations; we continue to analyze and improve our processes so we don’t miss anyone. We’ve found this is a personal decision. About 16 to 20 percent of patients and families elect to do something. Parents have been appreciative of the hope that that interaction brings. We come to them saying that we expect a good outcome from their therapy; it offers a light at the end of the tunnel.”

 

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