Shana and Charles Pear are a couple who feared that they would never have children after she was diagnosed with aggressive breast cancer in 2018.
However, the Pears’ daughter’s birth following a ground-breaking surgical procedure is a miracle for medical science as much as for the Pears. She is the first child to be born in England following over ten years of ground-breaking work by NHS doctors to assist both male and female young adults in becoming pregnant after cancer treatment.
Every year, some 300 kids and young adults, including Shana, have their reproductive organs taken and frozen, but until the Pear family’s daughter Sienna was born in April, no children had been born.
The two other women who are now expecting did so naturally after their ovarian tissue was implanted following their cancer treatment.
However, the National Paediatric Fertility Preservation Service programme of the NHS has been in operation since 2013 without any money from the government and is supported by the goodwill of doctors, nurses, and lab workers.
The National Paediatric Fertility Preservation Service was developed by doctors who believe their work could benefit tens of thousands of cancer survivors.
Sheila Lane, a consultant paediatric oncologist, said to the Times, “This is proof of concept.” Since the service’s inception in 2008, she is a senior lecturer who has served as its director from its base at Oxford University’s John Radcliffe Hospital.
“We offer a clinical service to children and young adults across the UK who are at high risk of infertility and who cannot store mature eggs or sperm. It’s quite unique in that sense and very much focused on their future.”
Around 1,800 children in the UK are diagnosed with cancer each year; eight out of ten will survive. Many will get infertile-ending chemotherapy and radiation treatment. Patients who need bone marrow transplants could also require radiation, which also eliminates their chances of becoming parents.
Fertility preservation
The practice of preserving fertility has become more popular recently. The need to think about fertility preservation has grown as cancer survival rates climb due to the long-term impact of ovary function loss.
In the Oxford area, a fertility preservation service is provided. Ovarian tissue cryopreservation is an alternative for young girls and women who must endure urgent medical treatment that could render them infertile (such as chemotherapy or radiotherapy).
Before receiving therapy, one of their ovaries is removed, and extremely thin pieces of tissue are separated and kept in cryogenic very low temperature freezers (cryopreservation). These tissue strips will be implanted back once the patients have recovered and are prepared to start families.
All cancer patients in England are eligible to receive financing for the cryopreservation of their gametes and embryos, however the eligibility requirements and time frames for storage differ greatly.
In Scotland, a national policy is in place, and health boards fairly allocate funds for the cryopreservation of gametes, embryos, and ovarian and testicular tissue for patients receiving treatment for benign and malignant disorders that impede fertility.
For patients receiving treatment expected to render them infertile in Wales and Northern Ireland, cryopreservation of gametes and embryos is reimbursed, however, ovarian tissue cryopreservation is not.
A first in England
Shana Pear had to go through stress and uncertainty as she was diagnosed with breast cancer at the age of 33 in February 2018. The couple turned to IVI, a reproductive centre in London’s Wimpole Street, for immediate assistance. Her cancer was so advanced that there was no time for the months-long process of standard IVF.
The Oxford team was sent to Shana because they thought the method, they were using for kids might also apply to her. Shana underwent surgery in Oxford less than a week after being diagnosed.
In contrast to IVF, the cryopreservation procedure involves gently removing an ovary through a small incision (keyhole surgery) and meticulously freezing tiny strips of tissue that contain eggs at a temperature of minus 180C, thereby hibernating the tissue.
Shana started chemotherapy in a matter of days. She underwent a double mastectomy and lymph node removal, followed by two years of medication, before having her ovarian samples reimplanted on to her surviving ovary.
Three eggs were collected by the IVI clinic following a few months of treatment. With her husband’s sperm, the first egg was successfully fertilised, and a typical, healthy pregnancy followed. To shorten the amount of time she had to cease using Tamoxifen, a hormone medication for breast cancer, she was not permitted to become pregnant naturally.
There is even a brilliant story of a cancer patient from Edinburgh who became the first UK woman to give birth following a transplant of her frozen ovary tissue. The mother conceived naturally and gave birth to a baby boy in early 2017.
When she was 22 years at the time when the mother had a portion of her ovary removed. Doctors re-implanted the tissue in early 2016 after her treatment.
Prof Richard Anderson, of Edinburgh University, said: “The storage of ovarian tissue to allow restoration of fertility after cancer treatment in girls and young women was pioneered in Edinburgh over 20 years ago, and it is wonderful to see it come to fruition.
Constraints to the service
Due to limitations on the service, which is provided entirely voluntarily by the doctors, not everyone can be assisted.
Nic Alexander, a consultant paediatric surgeon and the service’s national surgical lead, has taken tissue samples from roughly 140 patients at St Mary’s Hospital in Paddington, west London.
He claimed that the Oxford biobank has reached a critical point where they can only process two cases each day, which is a constraint. There have been a few instances where children were denied treatment due to a lack of time.
To legally commission a national service to pay for additional patients like Shana, NHS England is now looking over the suggestions.
According to Sheila Lane, it is essential for people to receive the assistance they need. She is aware that a sizable portion of individuals who experience infertility during adolescence suffer from severe mental health conditions. If a child had bone cancer, they would never think it was appropriate to amputate their limb and not provide them with a prosthesis so they could walk.
However, they publicly provide sterilising treatments like chemotherapy and radiotherapy to them, and up until recently, they hadn’t given any thought to helping them. Now that there is something they can do, in her opinion, it should be considered an essential component of cancer treatment.
According to NHS England, a consultation process will be launched on the plans in the future, which said it was presently investigating options to fund the service nationally.
