The Oncofertility Consortium--addressing fertility in young people with cancer

Abstract

The number of young cancer survivors is increasing owing to advances in cancer therapeutics, but many face infertility as a result of their treatment. Technologies that already exist for cancer patients concerned about their future fertility include sperm banking for men and hormonal intervention followed by in vitro fertilization and embryo cryopreservation for women. However, logistical barriers to timely patient referral and coordination of care between specialties can limit patient access to all the available options. Moreover, there are few alternatives for young women and girls who cannot delay their cancer treatment, or who are unable to undergo hormonal intervention. The Oncofertility Consortium is a network of researchers, physicians and scholars who are advancing fertility preservation options for young cancer patients. Research into the societal, ethical, and legal implications is also an important part of the work performed by the Oncofertility Consortium, which is providing new perspectives on patient decision-making about how to access these emerging reproductive technologies. Experts in the fields of oncology, reproductive medicine, the social sciences, law, education, and the humanities are working together to develop next-generation reproductive interventions and promote communication between scholars, clinicians, patients, and the public to ensure that young cancer patients are equipped with the most appropriate information and options for having a family in the future.

Figure 1

Structure of the Oncofertility Consortium. Three major gaps have prevented the fertility needs of young men, women, and children who face a cancer diagnosis and fertility-threatening treatment from being met. First, the science and supporting technology are not mature (scientific gap). Second, solving the problem requires an interdisciplinary approach by research and clinical communities (structural gap). Third, the work requires an unorthodox funding mechanism that supports diverse groups of investigators and scholars (tactical gap). The NIH Roadmap Grant, the National Physicians Cooperative, and basic and clinical research intersect and work together to ensure that advances in the laboratory are translated efficiently and safely to the bedside.

Figure 2

The National Physicians Cooperative. The National Physicians Cooperative is a federation of fertility programs that work together to share practice plans and ensure that patients receive the most authoritative and timely care. There are four core centers in the USA where research is being conducted (denoted in color): Northwestern University, Chicago, IL; University of Pennsylvania, Philadelphia, PA; Oregon National Primate Research Center, Beaverton, OR; University of California, San Diego, CA. An additional 68 allied centers are located across the USA (denoted by black dots; numbers indicate more than one center in the same location). A national fertility helpline (Fertline) is operated at Northwestern University on behalf of the entire network.

Figure 3

In vitro follicle maturation. a | Before cancer treatment, the ovary is removed and the outer cortex is dissected into small pieces that can be cryopreserved easily and may be transplanted at a later date. b | The tissue pieces contain a variety of follicle stages depending on the patient age and fertility status prior to cancer diagnosis. c–e | Immature cumulus oocyte complexes can be aspirated from the tissue and matured in vitro; eggs in metaphase II can then be cryopreserved for use at a later date. f | Immature human follicles can be isolated and matured in vitro in a three-dimensional biomaterial matrix (~140 μm). g | After 15 days in culture, morphological hallmarks of a developing follicle can be observed, including the antrum and the asymmetrically located oocyte (~400 μm). h | After 30 days, cultured human follicles reach the antral stage (~1 mm). i | The birth of viable and fertile offspring have been achieved using oocytes from mouse follicles cultured in vitro.