CHICAGO — Preserving life but threatening a patient’s ability to bring life into the world. That’s the dilemma with cancer drugs — some medicines rob young patients of their fertility. Even those much too young to understand the potential loss, now may have an option — the chance to freeze their fertility in time with the hope science will grow as they do.
Katie Palermo, cancer patient: “I was diagnosed with leukemia at the age of 12 before going into seventh grade. I got to start middle school bald as a girl, so that was really challenging.”
For two years, Katie Palermo underwent chemotherapy to fight her acute lymphoblastic leukemia. Her bone marrow was overproducing cancerous white blood cells while inhibiting the growth of normal cells. Now, at 15 and after a year in remission, her cancer is back.
Joan Vander Linde, Katie’s mother: “We thought we were done. We thought this was all behind us.”
The relapse means Katie is facing a possible stem cell transplant – and many more doses of chemotherapy.
Joan Vander Linde, Katie’s mother: “You’re always concerned of, ‘What does this mean for them later?’ Of course you want to cure them, and the most important thing is let them be cured, let them live a full, happy life. My next thought was, what impact will this have on the rest of their life? I said, ‘Will this impact her fertility?’ And she said, ‘That’s an excellent question.’”
Barbara Lockart, Lurie Children’s nurse practitioner: “Chemotherapy can speed up that aging process, so the body kills off our eggs quicker than it would if we hadn’t received chemotherapy.”
Katie’s additional treatment would likely wipe out her ovarian reserve – meaning the number of eggs her body can produce in her lifetime. Evelyn Kelly’s parents faced the same scenario after learning their daughter had a cancerous tumor in her heart sac.
Alyssa Kelly, Evelyn’s mother: “I decided when we were in the hospital that if she needed chemo that I wanted one of her ovaries removed. I didn’t want them damaged by treatment.”
Nurse practitioner Barbara Lockart’s job is to counsel young patients and their parents about fertility preservation options.
Barbara Lockart: “I’ve counseled patients as young as six, seven, eight. Sometimes they’ll say, ‘My mom’s such a great mom, I want to be just like she is.’ So if you listen to the message a lot of times young patients say, ‘I’m looking forward to the future, and I know I want to have children.’”
Alyssa Kelly: “She’s like all little girls. She loves to play with dolls. She’s a very mothering little girl.”
So at the age of three, Evelyn became the youngest Lurie Children’s patient to undergo ovarian cryopreservation – a procedure designed to freeze a young patient’s ovary for potential future use. Together with her parents, Katie made the same choice.
Katie Palermo: “Being twelve when it initially happened, I’m like, ‘Kids! Gross!’ And now I’m like, I’m 15. I’m still like not having kids right now, not for a while.”
Joan Vander Linde: “This is something that, although she may not understand, we’d like her to have. For us, we wanted to give her options.”
Just weeks into her relapse and retreatment — and with her thinning hair shaved away – Katie is prepped to have one of her ovaries removed.
Dr Erin Rowell, Lurie Children’s surgeon: “The goal here is to preserve the ovary and to preserve an ovary that has not gotten medicines yet that will make the oocytes, which are the little ovarian cells, not function.”
Lurie surgeon Dr Erin Rowell removes the organ laparoscopically through tiny incisions.
Dr Erin Rowell: “From the time that the blood vessel is divided, we want that ovary to go into the preservation media, it’s a solution that preserves that ovary perfectly in time, right at that minute.”
The ovary is then carried over to Northwestern Memorial Hospital, where, if the patient chooses, it’s divided. In Katie’s case, 80 percent of her ovary will be frozen and stored for her future use. The remaining 20 percent will go to researchers hoping to harness its potential.
Shuo Xiao, PhD: Northwestern Medicine oncofertility researcher: “Here is the human tissue we just got this afternoon.”
For nearly a decade, Northwestern Medicine researchers have been trying to grow a human egg from the ovarian tissue samples. They’ve had success in animal models – baby mice have been born from the experiment. But for now, there is only the hope the science will grow as the young patients do, so when they are ready, they may have viable eggs to use for in vitro fertilization.
Alyssa Kelly: “We’ve made so many decisions for her. We made the best decisions we could with the information we had, but you still wonder, ‘Did we make the right decision?”
A study of pediatric cancer survivors now in their 20’s and 30’s may offer a bit of reassurance.
Barbara Lockart: “Back when they were treated as children they weren’t given the option of fertility preservation. The overwhelming majority of them say they are sad and depressed that they didn’t have fertility preservation options, so we do know this is important to our patients when they are adults.”
Katie Palermo: “I think it will just be kinda cool to be able to say you have that option, not everyone can say, ‘Oh, I have an ovary in the freezer if I need it.’”
Alyssa Kelly: “Evelyn’s remarkable. She’s bright, she’s strong, she’s got a wicked sense of humor, and if she so chooses, she will be able to be a mother.”
By removing only one ovary there is no impact to a growing girl’s hormones. But for cancer patients, some chemotherapy drugs or radiation to the pelvic area or brain can impact the reproductive system. Currently there are 18 hospitals in the United States offering ovarian cryopreservation. And there are programs for males as well.
If you’d like to learn more about the fertility preservation program at Lurie Children’s, go to:
To learn more about the Oncofertility Consortium, a national, interdisciplinary initiative designed to explore the reproductive future of cancer survivors, go to: http://oncofertility.northwestern.edu
The Evelyn Kelly research fund at Lurie Children’s Hospital of Chicago was established in 2014 to raise funds to support pediatric oncofertility research. To learn more, check out: