Women and girls with cancer in Britain are now able to have groundbreaking treatment to preserve their fertility after the ravages of chemotherapy and radiotherapy – on the NHS.
Three NHS centres are offering ovarian tissue cryopreservation, a procedure that involves removing and then freezing healthy ovarian tissue containing eggs before the start of cancer treatment that is lifesaving but can permanently damage the reproductive system.
Once a patient has finished their treatment and is either in remission or of childbearing age, the ovarian tissue is thawed and re-implanted in an ovary or the lining of the womb.
The woman can then try to conceive naturally, as the implanted strips begin producing healthy eggs. Re-implanting healthy ovarian tissue can also help prevent premature menopause, another side-effect of some cancer treatments.
Currently, women may be offered the opportunity to freeze individual eggs if chemotherapy or radiotherapy is likely to damage fertility.
But some women are not suitable for egg freezing because their cancer needs treating urgently and they cannot wait for the ten to 14-day course of hormone injections needed to mature eggs. If cancer strikes before puberty, eggs cannot be harvested so freezing is impossible.
Some cancers, including severe leukaemia in childhood or solid muscle tumours, are treated using kinds of chemotherapy – called alkylating agents – which damage fertility. Total body irradiation before a bone marrow transplant also irreversibly damages the ovaries.
The new procedure allows doctors to remove an ovary through a keyhole incision, under general anaesthetic, and harvest the tissue and eggs lying just under its surface.
All of a woman’s eggs for her lifetime can be found in the thin 1mm outer layer of the ovary. The inside of the ovary is a ‘pulp’ of blood vessels that feed the eggs on the periphery. The extracted tissue is cut into 5mm x 15mm strips, each containing many eggs, and then frozen. The blocks can be thawed and re-implanted later to restore fertility.
The procedure is also being offered by some private clinics as a fertility-preserving treatment for women who wish to delay motherhood for lifestyle or other reasons. This option is not available on the NHS.
Professor Nick Macklon, consultant in obstetrics and gynaecology at University Hospital Southampton NHS Foundation Trust (UHS) and professor of obstetrics and gynaecology at the University of Southampton, said: ‘It is distressing for cancer patients to learn that they may become infertile as a result of their cancer treatment and not all girls or women can benefit from freezing embryos and eggs.
'This technique opens up the possibility to preserve fertility for many more women and for girls too.’
The technique has been used successfully worldwide for years, but stringent regulations mean that just three UK centres are licensed to perform the procedure, and only on a case-by-case basis.
They are the Princess Anne Hospital in Southampton, John Radcliffe Hospital in Oxford and The Royal Infirmary in Edinburgh.
Southampton has been offering the procedure since November, and takes referrals from all over the UK.
The option is also successful: 68 babies have been born worldwide using frozen ovarian tissue, with the first British birth reported in July this year to a 31-year-old from Edinburgh.
Last year, an unnamed 27-year-old woman in Belgium was the first in the world to have a baby using ovarian tissue which was frozen before puberty.
She was just 13 when she had the procedure before invasive treatment for sickle cell anaemia, showing that immature eggs could ripen successfully.
One of the first British patients is Tori Coles, 27, owner of Wight FIT gym in Newport, Isle of Wight, who was diagnosed with breast cancer last October.
‘It was devastating to hear that I had cancer, and that there was a risk that chemotherapy might also end my chance of having children,’ she says.
Egg harvesting was out of the question: the tumour was very aggressive, and she needed treatment urgently.
In November she became the first Southampton patient to have ovarian tissue harvested, which doctors can re-implant once she is cancer-free and wants to start a family.
After gruelling surgery, chemotherapy and radiotherapy, Tori had the all-clear in May. ‘I’ve always wanted children, and it’s wonderful to think this pioneering treatment has given the best chance of preserving my fertility,’ she said.
Professor Adam Balen, spokesman for the Royal College of Obstetricians and Gynaecologists (RCOG) and chairman of the British Fertility Society (BFS) welcomed the NHS initiative.
He said: ‘In the UK, both freezing ovarian tissue and freezing eggs are safe and effective treatment options for women prior to cancer treatment. However, currently, ovarian tissue cryopreservation is only available to NHS patients on a case-by-case basis. It’s hoped it will soon be an option for more women across the UK.
‘Around 23,600 women of childbearing age are diagnosed with cancer each year in the UK. These women deserve specialist care so that we can preserve fertility as much as possible and provide them with the best opportunity of having a family in the future.’
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