The University of Calgary’s Cumming School of Medicine is one of a handful of ovarian tissue cryopreservation programs in Canada.ADRIAN WYLD/The Canadian Press
For an Alberta father and his then nine-year-old daughter, a new approach to preserving fertility offered a glimmer of hope after their lives were shattered by cancer.
The father’s wife and the mother of his daughter died in 2020 at the age of 40, just four months after she was diagnosed with a rare and aggressive type of ovarian cancer that usually kills women when they’re barely out of their teens.
Doctors in Calgary quickly discovered the girl had the same dangerous genetic mutation. They and the father decided the safest course of action would be to remove her ovaries before she hit puberty, a step that until recently would have meant she had no prospect of one day having a biological child.
Instead, doctors offered to freeze her ovarian tissue, making her one of the first pediatric patients in Alberta to undergo the procedure as part of a program at the University of Calgary’s Cumming School of Medicine, one of a handful of ovarian tissue cryopreservation programs in Canada.
“My daughter was offered something I never had,” the father told The Globe and Mail in an interview.
The offer was especially meaningful to him because he was rendered sterile as a child after undergoing radiation treatment for leukemia. His children were conceived with donated sperm. The Globe agreed not to name him or his daughter to protect the privacy of the girl, who is now 11.
Ovarian tissue cryopreservation is giving young cancer patients fertility-restoration options that didn’t exist in Canada until just a few years ago, according to experts in oncology and reproductive technology. More than 200 babies have been born around the world after reimplanted ovarian tissue restored adult women’s periods and made them capable of conceiving a child – sometimes naturally, other times with the help of fertility treatments.
The Calgary program’s leaders and the Canadian Cancer Society are among the groups now advocating for public funding of the procedure, which costs thousands of dollars.
“Families that have heard about it are very, very hopeful,” said Shu Foong, a clinical assistant professor at the University of Calgary and leader of the division of reproductive endocrinology and infertility for Alberta Health Services’ Calgary zone. “They are very, very thankful to just have at least this piece of hope stored away.”
Until recently, prepubescent girls who were preparing to undergo cancer treatments or bone marrow transplants that might leave them infertile had no way of safeguarding their fertility for the future. Girls don’t produce mature, viable eggs – the kind that grown women regularly put on ice in hopes of having a baby years later – until after puberty.
In most cases, ovarian tissue cryopreservation begins with the removal of one ovary through minimally invasive surgery. The cortex, or outer layer of the ovary, where primordial follicles reside, is then sliced away, bathed in a cryopreservation solution and slowly frozen. The tissue can be thawed years later and reimplanted in its native location in a woman’s lower abdomen, restoring her fertility.
No live babies have resulted from this technique in Canada because it is so new, Dr. Foong said. The Canadian Fertility and Andrology Society only deemed it non-experimental in 2020, following the lead of the American Society for Reproductive Medicine and other international fertility groups.
The Calgary program has frozen ovarian tissue in about 15 cases, Dr. Foong added, most of them in the last year or so.
Toronto’s Mount Sinai Hospital, in partnership with the Hospital for Sick Children, has also frozen the ovarian tissue of more than a dozen patients in the last year, most of them children, according to Jennia Michaeli, who leads the ovarian tissue cryopreservation program at Mount Sinai. (Some adult women choose the procedure over egg freezing as well, often in urgent cases where they can’t delay surgery, radiation or chemotherapy to undergo a typical egg harvesting first.)
The youngest patient to undergo the procedure in Toronto was just 5, said Dr. Michaeli, who added that a hospital in Montreal offers the novel technique as well. Most of the parents she’s dealt with are excited to hear that freezing their daughter’s ovarian tissue is even a possibility.
Kelly Wilson Cull, director of advocacy for the Canadian Cancer Society, said her organization is urging provincial and territorial governments to publicly fund ovarian tissue freezing along with a broad range of fertility services for cancer patients. As it stands, coverage differs from province to province.
“Cancer patients are just experiencing such a tremendous toll from an emotional, physical and psychosocial perspective,” Ms. Wilson Cull said. “So adding the weight of fertility services really compounds all of that.”
In Alberta, where the nine-year-old girl had her ovarian tissue frozen in 2021, the office of Health Minister Adriana LaGrange said by e-mail that fertility procedures “are not covered at this time,” because the province’s health plan only covers “medically required physician and hospital services.”
Despite that, the father – whose story the University of Calgary made public this week – did not have to pay the approximately $3,000 Dr. Foong said it would have cost to harvest and freeze the girls’ ovaries. The hospital agreed to cover it, something Dr. Michaeli of Mount Sinai said her hospital, along with SickKids, has decided to do, too.
However, the Alberta father is doling out about $750 a year for storage of his daughter’s ovarian tissue, a price he is willing to pay even though her odds of conceiving a biological child are longer than those of other girls in a similar boat.
Reimplanting her ovarian tissue would be too dangerous because of her genetic mutation, he explained. But doctors told him there is good reason to hope that by the time his daughter is grown, scientists will have figured out how to stimulate her ovarian tissue to produce eggs in a lab that could be screened for the mutation before implantation.
“The doctor really believed that it was worth a shot,” he said, “so much so that they offered the procedure at no cost to me.”