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At Magee-Womens Hospital of UPMC, Fertility Preservation Is a Testament to Hope
By Nancy Kennedy

Joseph L. Kelley

At Magee-Womens Cancer Program of UPMC's CancerCenter, a remarkable program is bringing new hope to patients and new meaning to the phrase, "life after cancer."

That program is called Fertility Preservation, and it is a multidisciplinary effort to protect the reproductive capacity of women and men of childbearing age who have treatment for cancer. Chemotherapy, radiation and surgery can compromise and even destroy fertility, but the physicians and researchers at Magee have solutions that greatly improve the odds that cancer survivors can become pregnant or father a child, by intervening before cancer treatment even begins.

Every year, greater numbers of people survive cancer, thanks to improved treatment. As cancer survival rates have risen, oncology professionals at Magee, including Joseph L. Kelley, M.D., Director of the Division of Gynecologic Oncology, have placed new emphasis on life after cancer. Known as "survivorship," this is evolving into a medical specialty within cancer care; it addresses the lifelong special care that cancer survivors require to assure their continuing health and well-being. It encompasses follow-up care, monitoring, and treatment of "late effects" of cancer treatment, as well as patient education, counseling and health promotion. "Cancer treatment, traditionally, has focused on the cancer itself," says Kelley. "With improved survival, the focus shifts and encompasses adverse and long term effects as well. Essentially, survivorship represents the transition back to normalcy and wellness, and a strategy to maintain that wellness."

And for some cancer survivors, that may mean having a family of their own.

Cancer and cancer treatment can result in diminished fertility or loss of fertility; the type of cancer, type of treatment, and age of the patient are factors that determine the degree of risk. According to Kelley, "When a person is diagnosed, they face overwhelming issues – particularly their mortality. They also have to confront the sequelae of treatment, which can be life-altering. For patients of childbearing age, and for children, one of the concerns is the potential loss of fertility, but we now have the means to preserve fertility more often than in the previous decade. Before we begin treating the cancer, we talk to the patient about how the treatment may affect their ability to reproduce; not every treatment affects fertility." Kelley says that this a team effort, with collaboration from oncologists, reproductive endocrinologists, maternal-fetal medicine specialists and others. "We get the whole team involved at the beginning. We identify the risk and consider the potential adverse effects and their impact on the patient's quality of life."

Preservation of fertility can take many forms, from physical or chemical shielding of the ovaries or testicles, to surgery to relocate organs, but the standard is cryopreservation (freezing) of eggs, sperm, embryos and even ovarian or testicular tissue. New technologies are always being explored and developed, and Magee-Women's Research Institute (MWRI) is one of the leading centers for this pioneering research. Kyle Orwig, Ph.D., Principal Investigator for the Fertility Preservation Program at Magee, says that the field is a new and growing one and that Magee is has a unique place within it.

Dr. Orwig and his colleagues have established a fertility preservation hotline (412-641-7475) that is monitored continuously by knowledgeable medical professionals to educate patients and their physicians about the reproductive risks associated with their individualized cancer treatments as well as options for preserving their fertility. "Here at Magee and UPMC, we have a single, integrated center where we are treating women and men, girls and boys, in a tremendously collaborative environment. For children with cancer, this is a huge issue; 83% will survive their cancers and have their entire reproductive lives ahead of them." Peter Shaw, M.D., is a pediatric hematologist/oncologist at Children's Hospital of Pittsburgh and a collaborator with Dr. Orwig. "When the diagnosis of cancer is made, we do our best to inform the patients and families about the effects on future fertility," he says. "We discuss the side effects of the therapy and their fertility-sparing options. Talking about future childbearing adds to a feeling of hope for patients and families."

Coverage of fertility preservation by health insurance companies varies, and Orwig says that in Pittsburgh, these procedures are typically not covered. Part of his work, he says, is education – of the physician community, the public and perhaps in the future, the insurance industry in Pittsburgh. "This is an education and policy battle that has been fought successfully on behalf of patients in other parts of the country," he says.

At Magee, cancer care is advanced, effective and visionary, focused on the individual and concerned with not only the best treatment approaches, but also with the whole of that person's life. The care of people with cancer is a specialty at Magee, and the hospital is a national leader in cancer care, especially women's cancers. Magee's outcomes reflect this highly positive trend; in fact, Magee exceeds National Cancer Data Base figures for breast and gynecologic cancers. Magee's Fertility Preservation Program (http://www.mwrif.org/220) is a testament to the hope and optimism that these trends represent for those with cancer, their families and their doctors.

For additional information contact 1-866 MyMagee (696-2433) or Magee.UMPC.com.

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