Selected Podcast
Fertility Preservation: What You Need to Know
In this panel discussion, Dr. Arbuckle, and Dr. Sukhkamal Campbell discuss oncofertility.
Featuring:
Learn more about Sukhkamal Campbell, MD
Sukhkamal Campbell, MD | Janeen Arbuckle, MD, PhD
Sukhkamal Campbell, MD is the Director of Fertility Preservation Services.Learn more about Sukhkamal Campbell, MD
Dr. Arbuckle completed the dual MD/PhD program at the University of Oklahoma Health Sciences Center. She did her residency in Obstetrics and Gynecology at the University of Alabama at Birmingham where she also completed a fellowship in Pediatric and Adolescent Gynecology.
Learn more about Janeen Arbuckle, MD, PhD
Learn more about Janeen Arbuckle, MD, PhD
Transcription:
Dr Warner Huh: Hello, everyone. My name is Warner Huh. I'm the Chair of the Department of OB-GYN at the University of Alabama Birmingham. I'd like to welcome you to this podcast as a part of the series Women's Health with Dr. Huh.
Today's topic is going to be on fertility preservation and oncofertility, something that I am really excited about talking about. And I'm going to welcome my two guests, Dr. Janeen Arbuckle, who is an associate professor in Women's Reproductive Health Division at the Department of OB-GYN at UAB, and as well as Dr. Sukhkamal Campbell, who is an assistant professor in the Division of Reproductive Endocrinology and Infertility again here at UAB.
So welcome to both of you.
Dr Janeen Arbuckle: Thank you.
Dr Sukhkamal Campbell: Thank you.
Dr Warner Huh: So, this is great. I'm really excited about having both of you here. So can you, maybe Dr. Campbell, tell me a little bit about what exactly is fertility preservation and oncofertility for our listeners.
Dr Sukhkamal Campbell: Sure. So oncofertility or fertility preservation is the process of helping patients kind of protect their future ability to have a child after their cancer diagnosis or after their cancer treatment. It involves consultation with a reproductive specialist to discuss their goals and their future desires, as well as kind of the options that we have available prior to treatment start to help protect their future fertility. And these services are provided in partnership with their oncologist who care for these patients closely. And we communicate the patient's desires with them.
Dr Warner Huh: And so again, this is not just for patients who have cancer, but anyone really who is interested in preserving their future fertility for whatever medical reason or otherwise. Is that correct?
Dr Sukhkamal Campbell: Right. Exactly.
Dr Warner Huh: Okay. So Dr. Arbuckle, I was hoping that maybe you can comment on the treatments that commonly affect future fertility.
Dr Janeen Arbuckle: Yeah. We typically think of those therapies that might injure the ovary and its ability to mature eggs as being those are going to be most likely to affect their future fertility. Commonly, therapies that are used to treat cancer, specific chemotherapies are going to be the biggest offenders, but we also see some damage to the ovary with radiation to the pelvis.
Dr Warner Huh: And so just to be clear to the listeners, it's really any chemotherapy that's used for any malignancy that could be damaging to the ovary, would that be correct?
Dr Janeen Arbuckle: That's exactly correct. So it doesn't have to be a gynecologic cancer that affects the gynecologic system, but any cancer.
Dr Warner Huh: And then we're obviously most concerned about radiation therapy that's targeted in the pelvic area where the ovaries exist.
Dr Janeen Arbuckle: That's correct.
Dr Warner Huh: Okay. All right. I mean, I think that's really important to understand that irrespective of what kind of cancer an individual has, that if they're getting treated with most of the common chemotherapies, they are at risk for future infertility.
Dr Janeen Arbuckle: That's correct.
Dr Warner Huh: So along those same lines, Dr. Arbuckle, I was wondering maybe you can comment on the options on how one preserves their fertility.
Dr Janeen Arbuckle: Yeah. So the major thing that our goal is to retrieve and preserve oocytes. And women can undergo various simulation cycles to retrieve their oocytes and either preserve them as oocytes, the individual cells or, if they're partnered, merge them with their partner sperm in the form of an embryo. And then that embryo can then be preserved.
Dr Warner Huh: And what do you do in the circumstance in which, let's say, a patient is about to receive radiation? Let's say radiation to the pelvis.
Dr Janeen Arbuckle: Yeah. So a lot of malignancies do need to be treated by radiation. And we also have the option to move the ovaries from their traditional location in the pelvis into an area where they would not be in that radiation field.
Dr Warner Huh: So again, just to recap, so what I'm hearing in terms of preservation is that you can preserve either the oocytes or the eggs or combine the eggs with sperm and create an embryo and preserve the embryo, is that correct?
Dr Janeen Arbuckle: That's exactly right.
Dr Warner Huh: Okay, good. So Dr. Campbell, can you comment on newer technologies or approaches for addressing fertility preservation?
Dr Sukhkamal Campbell: Sure. So one of the newer techniques that we have more commonly available now is ovarian tissue cryopreservation, which is just freezing strips of pieces of the ovary to use at a future time. And previously, this was only an option that was done as part of a research study or a protocol for young girls who had not yet gone through puberty. But now, it's being offered in many places as an option for all women, maybe those who don't have time to pursue egg freezing through IVF, which can commonly take two weeks.
And it's done through surgery, through laparoscopy. Portions of the ovary are removed and then frozen in time basically until the patient has completed their treatment. And it can be re-transplanted back into the ovary or even into another site in their body for ovarian function and for the possibility of future fertility.
Dr Warner Huh: I think that is absolutely amazing. So what I'm hearing from you is that you could take a portion of your ovarian tissue that has eggs or oocytes, store that, and then reimplant that to be used for a future date to basically acquire oocytes so the patient she can get pregnant.
Dr Sukhkamal Campbell: Yeah. It's pretty amazing technology.
Dr Warner Huh: Twenty years ago, I think that would be totally unheard of and I think that's incredible. But just to be clear, this is progressively becoming a part of the standard of care for fertility preservation.
Dr Sukhkamal Campbell: Exactly. It's becoming more commonly used and offered in many institutions for all women that could pursue fertility preservation.
Dr Warner Huh: And I have to ask, I mean, this is something that we obviously offer at UAB as well.
Dr Sukhkamal Campbell: We're getting there. We're starting to develop our protocols so that we can also offer it in conjunction with specialists like Dr. Arbuckle or pediatric, who could harvest the tissue for preservation in the future.
Dr Warner Huh: It's amazing.
Dr Sukhkamal Campbell: Yeah. So cool.
Dr Warner Huh: So, in the interest of being sort of balanced to our listeners, so they understand the other side, which is, you know, obviously we're hearing these amazing technologies that are being developed, could you talk about the timeline related to this and like what can patients expect? So if they want to do this, what's the time investment to do it?
Dr Janeen Arbuckle: Yeah. So the goal in oocyte and embryo preservation is to stimulate the ovaries to get the maximum number of eggs or oocyte from the ovary. And it was traditionally thought that you had to be in a particular part of your cycle. In reality, that can be started at a random time with relationship to your menstrual cycle. So if a patient was in need of pretty rapid turnaround and needed to pursue chemotherapy, they would be able to start their simulation cycle and retrieve oocytes within about two weeks.
When we talk about that therapy that Dr. Campbell was discussing, as far as ovarian tissue cryopreservation, that can be done really just immediately before the patient begins their therapy. It can be done concomitantly with another procedure that might ultimately need to be done to deliver their chemotherapy.
Dr Warner Huh: So it sounds like that patients have to be relatively proactive knowing this information, if they're going to take advantage, particularly if they're being treated for cancer.
Dr Janeen Arbuckle: That's right. So ideally you would intervene before they've started any type of gonadotoxic therapy.
Dr Warner Huh: And so my advice to the listeners, for those of you that are interested, particularly for our cancer patients or patients who are unfortunately been diagnosed with cancer, you all would agree that, the advice is to ask about the services that are available and to seek them in a timely fashion because obviously time is of the essence. I'm assuming you guys would agree with that?
Dr Janeen Arbuckle: Absolutely.
Dr Sukhkamal Campbell: Yes, definitely.
Dr Warner Huh: Okay. What about other barriers, barriers including costs? Again, I want to be fair and balanced when we're having this conversation. So could you give the listeners a sense of how those costs are covered, Dr. Campbell? Obviously, not everyone can afford this and what they should expect.
Dr Sukhkamal Campbell: Right. That's a really good point. You know, one of the biggest issues that we face with our patients is often the barrier of cost. Many states do not have mandates for insurance coverage. Even for treatment, such as cancer treatments, which cause infertility, there's no insurance mandate in Alabama to pay for those therapies for our patients, which is a huge disservice at times, because cost is prohibitive for them.
Other barriers could be their concern regarding their disease and not wanting to delay their treatment for fear that they may be worsening their prognosis by a time delay of even two weeks. Thankfully, most studies have kind of shown that a two-week time delay is not significant in their overall survival, which can be encouraging to patients.
Also another barrier would be for providers. Time delays in clinic and not having the time to discuss fertility when they've already addressed many other challenging topics with the patient, like their new diagnosis and treatment plans and things like that. So there's kind of barriers on both sides, both for the patient, but also for the provider that could prevent these discussions from happening.
Dr Warner Huh: Okay. That's amazing. So I think what I'm hearing from you is, again, that the short delay is not likely to negatively impact their outcomes. But again, for the listeners, given the permanency of many of these treatments on one's fertility, I would think that it's time probably well spent at the minimum to get the information, so you can make an informed decision about whether or not to pursue this path.
Dr Sukhkamal Campbell: Right. Exactly. I think it's beneficial even if patients choose not to pursue fertility preservation, to just have that conversation and maintain their autonomy to make that decision for themselves.
Dr Warner Huh: Okay. Well, you know, it's been amazing to me because I think that there is clearly a growing population of women that are pursuing fertility preservation for whatever reason. And it kind of blows my mind that we have these options that are available to patients. But I don't know if you guys have any closing comments or thoughts that you want to share with the listeners.
Dr Sukhkamal Campbell: I think it's important for patients to be proactive, like you suggested Dr. Huh. You know, asking their providers for referral early in the process to a reproductive specialist that can have those conversations with them and to not be afraid to bring up that topic of fertility, because they may, due to the fear of their cancer, not talk about it. And then in the future, on the other side, when they've been treated, maybe have some regrets about that. So it's important to bring it up and talk about it with your provider.
Dr Warner Huh: Yeah. So it's a little bit about explaining the technology and the process, but about awareness as well.
Dr Sukhkamal Campbell: Definitely.
Dr Warner Huh: Yeah. That's great. That's awesome.
This concludes this podcast for Women's Health with Dr. Huh. Again, I wanted to thank Dr. Arbuckle and Dr. Campbell for your time and expertise. This was a really an amazing conversation.
Dr Sukhkamal Campbell: Thank you for having us.
Dr Janeen Arbuckle: It was a pleasure.
Dr Warner Huh: Great. As always, to our listeners, if you could comment and subscribe to this podcast, it'd be greatly appreciated. We always welcome topics and suggestions for things that you want to hear from our group of experts. But hope you have a great day and feel free to gather additional information from UABMedicine.org. I hope you all have a great day. Thank you.
Dr Warner Huh: Hello, everyone. My name is Warner Huh. I'm the Chair of the Department of OB-GYN at the University of Alabama Birmingham. I'd like to welcome you to this podcast as a part of the series Women's Health with Dr. Huh.
Today's topic is going to be on fertility preservation and oncofertility, something that I am really excited about talking about. And I'm going to welcome my two guests, Dr. Janeen Arbuckle, who is an associate professor in Women's Reproductive Health Division at the Department of OB-GYN at UAB, and as well as Dr. Sukhkamal Campbell, who is an assistant professor in the Division of Reproductive Endocrinology and Infertility again here at UAB.
So welcome to both of you.
Dr Janeen Arbuckle: Thank you.
Dr Sukhkamal Campbell: Thank you.
Dr Warner Huh: So, this is great. I'm really excited about having both of you here. So can you, maybe Dr. Campbell, tell me a little bit about what exactly is fertility preservation and oncofertility for our listeners.
Dr Sukhkamal Campbell: Sure. So oncofertility or fertility preservation is the process of helping patients kind of protect their future ability to have a child after their cancer diagnosis or after their cancer treatment. It involves consultation with a reproductive specialist to discuss their goals and their future desires, as well as kind of the options that we have available prior to treatment start to help protect their future fertility. And these services are provided in partnership with their oncologist who care for these patients closely. And we communicate the patient's desires with them.
Dr Warner Huh: And so again, this is not just for patients who have cancer, but anyone really who is interested in preserving their future fertility for whatever medical reason or otherwise. Is that correct?
Dr Sukhkamal Campbell: Right. Exactly.
Dr Warner Huh: Okay. So Dr. Arbuckle, I was hoping that maybe you can comment on the treatments that commonly affect future fertility.
Dr Janeen Arbuckle: Yeah. We typically think of those therapies that might injure the ovary and its ability to mature eggs as being those are going to be most likely to affect their future fertility. Commonly, therapies that are used to treat cancer, specific chemotherapies are going to be the biggest offenders, but we also see some damage to the ovary with radiation to the pelvis.
Dr Warner Huh: And so just to be clear to the listeners, it's really any chemotherapy that's used for any malignancy that could be damaging to the ovary, would that be correct?
Dr Janeen Arbuckle: That's exactly correct. So it doesn't have to be a gynecologic cancer that affects the gynecologic system, but any cancer.
Dr Warner Huh: And then we're obviously most concerned about radiation therapy that's targeted in the pelvic area where the ovaries exist.
Dr Janeen Arbuckle: That's correct.
Dr Warner Huh: Okay. All right. I mean, I think that's really important to understand that irrespective of what kind of cancer an individual has, that if they're getting treated with most of the common chemotherapies, they are at risk for future infertility.
Dr Janeen Arbuckle: That's correct.
Dr Warner Huh: So along those same lines, Dr. Arbuckle, I was wondering maybe you can comment on the options on how one preserves their fertility.
Dr Janeen Arbuckle: Yeah. So the major thing that our goal is to retrieve and preserve oocytes. And women can undergo various simulation cycles to retrieve their oocytes and either preserve them as oocytes, the individual cells or, if they're partnered, merge them with their partner sperm in the form of an embryo. And then that embryo can then be preserved.
Dr Warner Huh: And what do you do in the circumstance in which, let's say, a patient is about to receive radiation? Let's say radiation to the pelvis.
Dr Janeen Arbuckle: Yeah. So a lot of malignancies do need to be treated by radiation. And we also have the option to move the ovaries from their traditional location in the pelvis into an area where they would not be in that radiation field.
Dr Warner Huh: So again, just to recap, so what I'm hearing in terms of preservation is that you can preserve either the oocytes or the eggs or combine the eggs with sperm and create an embryo and preserve the embryo, is that correct?
Dr Janeen Arbuckle: That's exactly right.
Dr Warner Huh: Okay, good. So Dr. Campbell, can you comment on newer technologies or approaches for addressing fertility preservation?
Dr Sukhkamal Campbell: Sure. So one of the newer techniques that we have more commonly available now is ovarian tissue cryopreservation, which is just freezing strips of pieces of the ovary to use at a future time. And previously, this was only an option that was done as part of a research study or a protocol for young girls who had not yet gone through puberty. But now, it's being offered in many places as an option for all women, maybe those who don't have time to pursue egg freezing through IVF, which can commonly take two weeks.
And it's done through surgery, through laparoscopy. Portions of the ovary are removed and then frozen in time basically until the patient has completed their treatment. And it can be re-transplanted back into the ovary or even into another site in their body for ovarian function and for the possibility of future fertility.
Dr Warner Huh: I think that is absolutely amazing. So what I'm hearing from you is that you could take a portion of your ovarian tissue that has eggs or oocytes, store that, and then reimplant that to be used for a future date to basically acquire oocytes so the patient she can get pregnant.
Dr Sukhkamal Campbell: Yeah. It's pretty amazing technology.
Dr Warner Huh: Twenty years ago, I think that would be totally unheard of and I think that's incredible. But just to be clear, this is progressively becoming a part of the standard of care for fertility preservation.
Dr Sukhkamal Campbell: Exactly. It's becoming more commonly used and offered in many institutions for all women that could pursue fertility preservation.
Dr Warner Huh: And I have to ask, I mean, this is something that we obviously offer at UAB as well.
Dr Sukhkamal Campbell: We're getting there. We're starting to develop our protocols so that we can also offer it in conjunction with specialists like Dr. Arbuckle or pediatric, who could harvest the tissue for preservation in the future.
Dr Warner Huh: It's amazing.
Dr Sukhkamal Campbell: Yeah. So cool.
Dr Warner Huh: So, in the interest of being sort of balanced to our listeners, so they understand the other side, which is, you know, obviously we're hearing these amazing technologies that are being developed, could you talk about the timeline related to this and like what can patients expect? So if they want to do this, what's the time investment to do it?
Dr Janeen Arbuckle: Yeah. So the goal in oocyte and embryo preservation is to stimulate the ovaries to get the maximum number of eggs or oocyte from the ovary. And it was traditionally thought that you had to be in a particular part of your cycle. In reality, that can be started at a random time with relationship to your menstrual cycle. So if a patient was in need of pretty rapid turnaround and needed to pursue chemotherapy, they would be able to start their simulation cycle and retrieve oocytes within about two weeks.
When we talk about that therapy that Dr. Campbell was discussing, as far as ovarian tissue cryopreservation, that can be done really just immediately before the patient begins their therapy. It can be done concomitantly with another procedure that might ultimately need to be done to deliver their chemotherapy.
Dr Warner Huh: So it sounds like that patients have to be relatively proactive knowing this information, if they're going to take advantage, particularly if they're being treated for cancer.
Dr Janeen Arbuckle: That's right. So ideally you would intervene before they've started any type of gonadotoxic therapy.
Dr Warner Huh: And so my advice to the listeners, for those of you that are interested, particularly for our cancer patients or patients who are unfortunately been diagnosed with cancer, you all would agree that, the advice is to ask about the services that are available and to seek them in a timely fashion because obviously time is of the essence. I'm assuming you guys would agree with that?
Dr Janeen Arbuckle: Absolutely.
Dr Sukhkamal Campbell: Yes, definitely.
Dr Warner Huh: Okay. What about other barriers, barriers including costs? Again, I want to be fair and balanced when we're having this conversation. So could you give the listeners a sense of how those costs are covered, Dr. Campbell? Obviously, not everyone can afford this and what they should expect.
Dr Sukhkamal Campbell: Right. That's a really good point. You know, one of the biggest issues that we face with our patients is often the barrier of cost. Many states do not have mandates for insurance coverage. Even for treatment, such as cancer treatments, which cause infertility, there's no insurance mandate in Alabama to pay for those therapies for our patients, which is a huge disservice at times, because cost is prohibitive for them.
Other barriers could be their concern regarding their disease and not wanting to delay their treatment for fear that they may be worsening their prognosis by a time delay of even two weeks. Thankfully, most studies have kind of shown that a two-week time delay is not significant in their overall survival, which can be encouraging to patients.
Also another barrier would be for providers. Time delays in clinic and not having the time to discuss fertility when they've already addressed many other challenging topics with the patient, like their new diagnosis and treatment plans and things like that. So there's kind of barriers on both sides, both for the patient, but also for the provider that could prevent these discussions from happening.
Dr Warner Huh: Okay. That's amazing. So I think what I'm hearing from you is, again, that the short delay is not likely to negatively impact their outcomes. But again, for the listeners, given the permanency of many of these treatments on one's fertility, I would think that it's time probably well spent at the minimum to get the information, so you can make an informed decision about whether or not to pursue this path.
Dr Sukhkamal Campbell: Right. Exactly. I think it's beneficial even if patients choose not to pursue fertility preservation, to just have that conversation and maintain their autonomy to make that decision for themselves.
Dr Warner Huh: Okay. Well, you know, it's been amazing to me because I think that there is clearly a growing population of women that are pursuing fertility preservation for whatever reason. And it kind of blows my mind that we have these options that are available to patients. But I don't know if you guys have any closing comments or thoughts that you want to share with the listeners.
Dr Sukhkamal Campbell: I think it's important for patients to be proactive, like you suggested Dr. Huh. You know, asking their providers for referral early in the process to a reproductive specialist that can have those conversations with them and to not be afraid to bring up that topic of fertility, because they may, due to the fear of their cancer, not talk about it. And then in the future, on the other side, when they've been treated, maybe have some regrets about that. So it's important to bring it up and talk about it with your provider.
Dr Warner Huh: Yeah. So it's a little bit about explaining the technology and the process, but about awareness as well.
Dr Sukhkamal Campbell: Definitely.
Dr Warner Huh: Yeah. That's great. That's awesome.
This concludes this podcast for Women's Health with Dr. Huh. Again, I wanted to thank Dr. Arbuckle and Dr. Campbell for your time and expertise. This was a really an amazing conversation.
Dr Sukhkamal Campbell: Thank you for having us.
Dr Janeen Arbuckle: It was a pleasure.
Dr Warner Huh: Great. As always, to our listeners, if you could comment and subscribe to this podcast, it'd be greatly appreciated. We always welcome topics and suggestions for things that you want to hear from our group of experts. But hope you have a great day and feel free to gather additional information from UABMedicine.org. I hope you all have a great day. Thank you.