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Docs aim to save fertility of ill children

WASHINGTON - The treatment beating back 9-year-old Dylan Hanlon's cancer may also be destroying his chances of fathering his own children when he grows up.

Upset that doctors didn't make that risk clear, his mother, Christine, tracked down an experiment that just might salvage Dylan's future fertility.

Many of the cancer treatments that can save patients' lives also may cost them their ability to have babies later in life. Young adults have options: bank some sperm, freeze embryos or eggs. Children diagnosed before puberty don't.

With childhood cancer survival reaching 80 percent, there's a growing need to find ways to preserve youngsters' fertility, and patients such as Dylan are on the leading edge of research that's banking testicular cells and ovarian tissue to try.

"There are viable options, and they are on the doorstep," says Dr. Kyle Orwig of the University of Pittsburgh. He leads the study Dylan joined to store the stem cells boys harbor that will produce their sperm later on. The idea is to transplant the cells back eventually.

It may sound odd to discuss fertility issues still decades away even as parents agonize over whether a child will live or die. Yet it can be hopeful:

"We expect they'll live that long," says Dr. Teresa Woodruff of Northwestern University's Oncofertility Consortium, who works with girls' ovarian tissue. "If we protect their fertility now as a 9-year-old, we hope . . . that tissue we've guarded can be used" when they're grown.

Researchers say several dozen boys and girls, including some babies, so far are part of these early-stage experiments at a handful of medical centers.

And while there are no guarantees, Dylan's mother rests easier knowing "that I'm doing all I can do" for his future.

About 10 percent of the 1.5 million people diagnosed with cancer last year were younger than 45, more than 15,000 of them under 20.

Woodruff says perhaps half of younger patients risk either some immediate fertility damage, or for girls the prospect of menopause in their 20s or 30s. It depends on the type of cancer and treatment. Numerous forms of chemotherapy, high-dose body-wide radiation, radiation aimed at the pelvis and some surgeries can leave patients unable to procreate.

Even young adults too often aren't told in time about fertility preservation options, despite 2006 guidelines urging doctors to discuss them upfront.

Where does that leave the youngest patients? Boys don't produce sperm before puberty, ruling out sperm banking. Girls are born with all the eggs they'll ever have but those are in an immature state, so egg-freezing isn't an option.

Enter the new research. Orwig and other researchers have restored fertility in a range of male animals - mice, rats, pigs, dogs - by storing and reimplanting sperm-producing stem cells.


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