In patients of reproductive age who have cancer, fertility preservation for potential children in the future should be a high priority. A practice article published in CMAJ (Canadian Medical Association Journal) https://www.cmaj.ca/lookup/doi/10.1503/cmaj.250519 describes the successful preservation of ovarian tissue in a young woman undergoing urgent chemotherapy and demonstrates a novel model of care for Canada.
"This case illustrates the complex challenges faced by young patients with cancer who desire biological children but require urgent treatment that threatens their reproductive potential," writes Dr. Jennia Michaeli, a fertility specialist at Mount Sinai Hospital, part of Sinai Health, and clinician–investigator and assistant professor at the University of Toronto, Toronto, Ontario, with coauthors. "Unfortunately, many life-saving interventions — including reproductive organ surgery, chemotherapy, and abdominopelvic radiation — increase the risk of infertility and reproductive endocrine dysfunction."
The patient, located 380 km from Toronto, decided to undergo ovarian tissue preservation after being counselled on options, the risks of surgery, and steps in the procedure. The fertility team at Mount Sinai in Toronto coordinated care remotely with the patient's local oncologist and gynecologist to ensure the tissue was removed surgically, then transported under continuous temperature control to a specialized embryology lab at Mount Sinai.
Despite Canadian guidelines endorsing fertility preservation as a standard of care for patients with cancer, patient distress around survival, a lack of physician knowledge of options, and limited capacity in the system pose barriers to wider adoption of the practice.
This patient's case shows that implementing a centralized "hub-and-spoke" model could help open the doors to ovarian tissue cryopreservation for young patients with cancer across Canada.
"We successfully delivered specialized oncofertility services through coordinated care pathways that overcome geographical barriers, which serves as a proof of concept," write the authors.
"The described model aims to reduce infertility and reproductive endocrine dysfunction, minimize the psychosocial impact of infertility, and enhance the quality of life for patients and their families by improving access and coordination of care."
