|CANCER & TREATMENTS FOR CANCER CENTER PATIENTS PREVENTION & RISK ASSESSMENT CLINICAL TRIALS & RESEARCH LIVING WITH CANCER|
U-M CCC - Progress Newsletter Summer 2003 Online
A Race Against Time
Armstrong had always wanted to be a father. When diagnosed with cancer, he not only had to overcome his disease, but he also had to overcome the sterility that his cancer and its treatment might render. As Armstrong recalls in his book, one week before his chemotherapy treatments began, he was told that he would be at least temporarily sterile and that he should bank as much sperm as possible. "It was the first time the subject of sterility had come up, and I was taken aback . . . There was a sperm bank two hours away in San Antonio, and (the doctor) recommended I go there,"wrote Armstrong.
Far too often cancer patients are sent off to commercial sperm banks to try to save a semen sample before their treatments begin. It's a race against the treatment clock. Patients may feel very alone as they are shuffled through commercial facilities with no regard for their unique situation. A new program at the University of Michigan Comprehensive Cancer Center is changing this.
The Fertility Counseling and Gamete Cryopreservation Program (FCGCP) is a joint effort of the U-M Cancer Center and the U-M Department of Obstetrics and Gynecology [more information about the Clinic at the end of this article]. The goal of the program is to bring the option of the latest reproductive technology directly to the cancer patient as part of their treatment.
"The whole idea is to not only provide the service, but provide education,"says Karen Hammelef, R.N., M.S., one of the program's administrators. Health care providers have always given their patients information about infertility. But this information might be lost among all the other information that patients must absorb when first diagnosed. "Patients now have a dedicated place to go to discuss their fertility options -- a place that understands what they are going through as cancer patients, a place that provides information on the latest cutting edge reproductive technology, and does this all in a timely fashion so as to keep the treatment clock moving,"says Hammelef.
"The patient can also rest assured that there will be constant contact with their primary treating physician,"she adds.
Started in Nov. 2002, the program offers counseling and education services, as well as semen collection and storage services, to male patients, newly diagnosed with cancer. As the program's coordinator, nurse practitioner Marcia Leonard, R.N., acts as the liaison between the referring physician and the Assisted Reproductive Technologies (ART) laboratory in the U-M Department of Obstetrics and Gynecology. "People don't understand how complicated therapy-related infertility is,"says Leonard. "They just want to know if they will be infertile after treatment, but in most cases the data are too incomplete to predict an individual outcome. The incidence of sterility varies widely depending on the location of the cancer, the patient's age, the fertility level before cancer, and the type, amount and intensity of treatment."
Leonard gently explains to patients that there are no guarantees. She helps them understand that medical assistance is always necessary to become pregnant using cryopreserved sperm. One of the most difficult and sensitive parts of her job is counseling teenaged boys who must deal with issues involving sexuality and reproduction before they have the emotional maturity to handle these issues.
Because cryopreservation technologies used to freeze eggs and ovarian tissue are still experimental, the program currently accepts only semen samples. "It all comes down to the size of the cell and what you expect it to do following thaw,"explains Gary Smith, Ph.D., director of both the ART and FCGCP. "Sperm are easy to preserve, because they are small and their primary function is to contribute genetic material. Eggs are large with multiple cellular components and complex functions. When eggs are frozen, ice crystals form inside causing internal damage that compromises the egg's viability and/or ability to support the myriad of tasks required for normal embryo development,"he continues.
In addition to counseling, one of the most important areas of the new program is its emphasis on research. Smith and other scientists affiliated with the program are currently working with laboratory animals to evaluate new technologies that could improve a woman's chances of preserving eggs or ovarian tissue that would be viable years later when they are thawed. A "flash-freeze" technique called vitrification, which eliminates ice crystal formation, shows a great deal of promise, according to Smith.
"Some laboratories will freeze eggs now on the assumption they will figure out how to maintain viability later,"says Smith. "But there's a fine line between reality and hype. We hope to be able to offer the service to women soon, with a realistic expectation of success."
The day Armstrong banked his semen was an awful day for him. He knew there was no guarantee that the semen saved would result in a healthy child, but he had hope -- hope for the research and technology of the future. And if he had learned one thing as a world champion cyclist, he had learned the power of hope, "I had learned what it means to ride the Tour de France. It's not about the bike. It's a metaphor for life; not only the longest race in the world but also the most exalting and heartbreaking and potentially tragic. During our lives we're faced with so many different elements as well, we experience so many setbacks and fight such a hand-to-hand battle with failure, head down in the rain just trying to stay upright and to have a little hope."
It's Not About the Bike -- My Journey Back to Life, by Lance Armstrong, Berkley Books, NY, 2001. Portions of this article have previously appeared in Medicine at Michigan.
A physician referral is required for appointments in the Fertility Counseling & Gamete Cryopreservation Program. For more information about the Program, contact the Cancer AnswerLine™ at 1-800-865-1125, 9 a.m. to 4:30 p.m., Monday through Friday, or visit their web pages.