The current program of research for oncofertility incorporates 8 areas of research that are hoped to provide benefits to a wide range of cancer patients and their families:
- Reproductive Data- The Fertility Understanding Through Registry and Evaluation (Future Fertility) project is registering paediatric, adolescents and adults below 45 years of age across Australia, India, New Zealand and the United States of America. The project will follow the reproductive decisions, complications and final outcomes that cancer patients face over a twenty – year period to be able to answer important questions on the risk of cancer treatment to patient’s fertility as well as the success and complications of fertility preservation and assisted reproductive treatment (ART).
Our research group also have other reproductive data linkage studies on ‘The Health Economic Analysis of Fertility Preservation’ and ‘Pregnancy Outcomes Following Cancer Treatment’ and ‘Cancer and Pregnancy Outcomes’.
- Models of Care- Despite international evidence about the benefits of fertility preservation and current national and international guidelines there are several barriers that have prevented the implementation of equitable fertility preservation practice around the world. These barriers include a lack of referral pathways and models of care for oncofertility services, the need for more collaborations between cancer and fertility doctors, inequitable access based on cost and a lack of oncofertility training. There is also no consensus about the best way to deliver oncofertility information to patients. Our group are currently developing competencies for health care services and health care providers to ensure that they develop knowledge, skills and processes to deliver services of a high standard and this includes suitable models of care and referral pathways.
- Reproductive Care in Survivorship- 1 in 10 cancer patients experience a reproductive complication due to a cancer diagnosis or treatment and these can cause a number of medical and psychological reproductive complications which can be life-altering, and they can negatively impact on the cancer survivors’ quality of life. Our studies are looking at the different models of reproductive survivorship care. The development of survivorship patient reported outcomes measures and studies looking at different options for parenthood (both biological and non-biological options).
- Psychosocial Care – A program of research into the psycho-social aspects of fertility preservation and ART and how these differ by age, gender, sexuality, cultural or religious factors. We also have two research collaborations on decision aid which help patients make decisions about fertility preservation; Paediatric Decision Aid Study led by Dr Jayasinghe in Melbourne University and Adult Decision Aid Study led by Dr Jones in Sheffield University.
- Developing Future Biomarkers – Study of new biomarkers for ovarian reserve and, critically, egg quality as well as quantity. Existing markers (AMH, AFC, FSH) give an estimate of the number of eggs remaining in the ovaries but none are derived from the egg and surrounding cells. UNSW are developing ways to make biomarkers derived from the egg (GDF9, BMP15, cumulin) and will be able to test their applicability in the cancer fertility setting by following serum markers during and after chemotherapy.
- Reproduction and Aging- In the Laboratory for Ageing we seek to understand and identify the fundamental causes of reproductive aging so that we can develop interventions which may prevent or repair reproductive damage caused by cancer treatment. We are currently pursuing a number of ongoing projects in the search for understanding and interventions that may delay ageing. These projects start with the sirtuins, a class of NAD+ dependent deacetylase enzymes implicated in mediating the effects of calorie restriction to extend lifespan. Recently, we have moved beyond these and are in particular excited about the identification of circulating hormones that could control ageing and lifespan.
- New Methods of Assisted Reproductive Treatment New techniques for maturing eggs in the laboratory (in vitro maturation (IVM)) using novel culture conditions to allow “hormone free” collection and storage of eggs for young people with cancer. There are concerns about the possible effects of the high oestrogen levels produced by the hormones used in IVF, as used in conventional strategies for egg collection and storage on the evolution of cancer, particularly ER positive breast cancers, which are seen in this group of patients. A hormone free approach would be clearly of benefit for these and other women who wish to avoid superovulation caused by hormones.
- New Fertility Preservation Approaches – New approaches to ovarian tissue freezing for women who need chemotherapy and who do not have time for an IVF cycle, or who are too young to undergo such treatment. Studies are needed to optimise the methods of tissue freezing, and UNSW will also study the best means of using this tissue later. Current techniques involve grafting the thawed tissue back into the patient but it may be preferable to also mature eggs in the laboratory (in vitro) from dormant eggs derived from the tissue samples. This approach would avoid the risk of regrafting cancer into the patient, from malignant cells stored within the tissue graft, and may improve success rates above the current poor results seen after tissue regrafting.