BackTable / OBGYN / Podcast / Episode #22
with Dr. Leslie Appiah
In this episode, Dr. Leslie Appiah, who is fellowship-trained in Pediatric and Adolescent Gynecology and is the Director of the Fertility Preservation Program at the University of Colorado, discusses oncofertility and fertility preservation.
BackTable, LLC (Producer). (2023, May 4). Ep. 22 – Oncofertility [Audio podcast]. Retrieved from https://www.backtable.com
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Dr. Leslie Appiah
Dr. Leslie Appiah is the director of the fertility preservation program and the chief of the division of academic specialists in OBGYN at the University of Colorado Anschutz.
Dr. Amy Park
Dr. Amy Park is the Section Head of Female Pelvic Medicine & Reconstructive Surgery at the Cleveland Clinic, and a co-host of the BackTable OBGYN Podcast.
Dr. Mark Hoffman
Dr. Mark Hoffman is a minimally invasive gynecologic surgeon at the University of Kentucky.
Dr. Appiah begins the episode by defining oncofertility as a multidisciplinary field that improves fertility and reproductive health outcomes for patients with cancer diagnoses. She emphasizes the growth of the field, with the term “oncofertility” being coined in 2009 by Dr. Teresa Woodruff at Northwestern University. Now, 13 states have legislation that mandates insurance providers to cover fertility services for patients with and without cancer.
The primary patient population that may benefit includes patients with a cancer diagnosis, although additional populations who may benefit, including patients with Sickle Cell Anemia undergoing bone marrow transplant, systemic lupus erythematosus using alkylator therapies, transgender populations undergoing gender-affirming treatments, and patients born with genetic conditions that may result in infertility (e.g., Turner Syndrome). The main agents that are harmful to fertility include alkylator and radiation therapies.
The physicians then transition to discuss fertility preservation, and Dr. Appiah highlights that it is the responsibility of medical providers to offer counseling for every patient who is at risk for infertility. She then describes types of fertility preservation, including sperm banking, testicular tissue preservation, egg freezing, and ovarian tissue cryopreservation. Dr. Appiah then shares 3 different procedures that are used for ovarian tissue cryopreservation, the most common approach begin a laparoscopic procedure to retrieve one ovary, which is then preserved and later transplanted back into the pelvic peritoneum once the patient has completed cancer therapies and is ready to start a family.
The episode concludes with Dr. Appiah shares future directions in the field of oncofertility, which includes streamlining the process for male patients, ensuring every state is able to allow fertility preservation services that are covered by insurance providers, optimizing the process of transplanting ovarian tissue, and utilizing ovarian tissues for hormone replacement.
ReproTech, Fertility Preservation:
Alliance for Fertility Preservation, Fertility Scout:
[Dr. Leslie Appiah]
To start off with, we should counsel all patients of reproductive age about the risk to their fertility and about the options. When I say reproductive age, I mean birth through age 42 for females or patients with ovaries and birth through the 60s for patients with testes and the children have reproductive potential. We want to counsel them about the harm of these therapies to their reproductive potential first. That is mandated, or I should say it is a standard of care as depicted or as stated by the American Society for Reproductive Medicine and the American Society for Clinical Oncology.
Every reproductive governing body, every oncologic governing body has stated that as medical providers, it is our responsibility to counsel every one of these patients or to offer counselling to every one of these patients who may be at risk. That's number one. Once we identify risk and the patient wants to proceed with fertility preservation options, there are several. For patients with ovaries, egg freezing is a standard of care. It is available to adolescents. I think historically we think about egg freezing for adult patients 18 and over but we can't freeze eggs in girls who have experienced menarchy. Success rates range anywhere from 50% to 60% in patients under age 35 years of age.
Sperm banking is standard of care for adolescent and adult males. They should be offered this opportunity. Ovarian tissue freezing is near and dear to my heart. It is a process where we would remove an ovary and then freeze the ovarian tissue prior to cancer therapies. Then when the patient has completed chemotherapy or radiation, we will transplant the tissue back into the pelvis when they're ready to have a family. Prior to December 2019, ovarian tissue cryopreservation was considered investigational. There now have been over 200 births worldwide. This is now considered clinical care. We do offer it to patients from several months of age to age 35.
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