At the age of 35 Wolf-Tinsman had all but given up hopes of conceiving a sibling for her son, Chase. As a young woman Wolf-Tinsman was diagnosed with Hodgkin's Disease. Her oncologist at the time performed a surgery that was intended to protect her uterus and ovaries by moving them away from the field of radiation, but the procedure caused subsequent scarring that made her prospects of fertility bleak.

Of the 200,000 estimated new cases of breast cancer this year, 1.5 percent will occur in women of childbearing age. Don't let it stop you from fulfilling your dream of raising a child.

"We had a long course of infertility treatment before Chase was conceived and I felt so grateful and so lucky to finally have him after what I'd been through ten years before," says Wolf-Tinsman, whose family was ecstatic when they found out last year that she was pregnant again. "I went to my first prenatal checkup at eight weeks just a happy as can be," Wolf-Tinsman says. "I told the doctor, sort of in passing, that I'd felt something strange in my breast. I thought maybe it was the milk glands enlarging or something, but I wanted to bring it up. My obstetrician said, 'well, pregnant breasts can be lumpy, but let's get an ultrasound and take a look at it.'"

The 'Sound' That Rocked Her World
The ultrasound sent Wolf-Tinsman's world crashing down when it detected a tumor. It also saved her life. She faced a devastating decision. Should she pursue the most aggressive treatment and risk losing the pregnancy or try a less aggressive regimen to protect the fetus?

"We decided to pursue the most aggressive treatment possible, which was an excruciating choice, but I knew that no matter what happened I had a little boy I wanted to raise," said Wolf-Tinsman. Today, her tumor is undetectable and Chase has a sister. Clearly, preserving her life was always paramount to Wolf-Tinsman. Yet for her and thousands of survivors like her, the prospect that chemotherapy might dash all hopes of bearing children can be a devastating side effect of life-saving treatments.

The American Cancer Society projects that by age 39, one in 51 women will develop some form of cancer. And of the 200,000 estimated new cases of breast cancer this year, 1.5 percent will occur in women of childbearing age. Most of the women will undergo chemotherapy and, as a result, most will be long-term survivors. Yet, half will suffer premature "therapy-induced" menopause, all but ruining their chances of bearing children. Leading cancer researches and reproductive medicine specialists say new advances in their fields brings new hope for breast cancer patients and survivors who want to protect the female reproductive system from the devastation of cancer drugs, so they can preserve their fertility and bear children.

"People think it's their right to get pregnant and have children and they know science is making it possible for women to overcome some very difficult barriers," says Dr. Jeanne Petrek, a breast cancer surgeon at Memorial Sloan-Kettering Cancer Center in New York City, who is one of the foremost researchers on pregnancy and breast cancer. "The successes the reproductive medicine specialists have had with infertility in the general patient, such as with in-vitro fertilization, for example, and all the amazing prospects coming out of basic science ­ certainly cloning is the most dramatic example ­ have raised hopes for everyone, including cancer patients," says Dr. Petrek.

A Focus on Fertility
While new breakthroughs in the lab bring promise to cancer survivors concerned about their ability to bear children, to date, there is no fail-safe method for preserving fertility, says Dr. Petrek, who is currently conducting a study involving 1,000 survivors that will be the first long-term investigation into the lifetime risks of post-cancer pregnancy. Nor is it known, she says, whether the high hormone levels associated with child-bearing pose any special risks to cancer survivors.

Finding ways to keep the body from killing off ovarian cells is one of the most promising avenues in fertility preservation research. Researchers have long known that as many as half the women of child-bearing age treated for cancer by conventional radiation therapy and chemotherapy undergo "premature menopause" or become sterile as a result of treatments designed to preserve their lives, according to Jonathan Tilly, director of the Vincent Center for Reproductive Biology at Massachusetts General Hospital. Tilly is the lead author of several studies published in the journal Nature Medicine, that may lead to treatments that protect the fertility of women who must undergo radiation or chemotherapy.

In 2001 Tilly's team published a study carried out on mice genetically engineered to have human ovarian tissue. The research showed that a compound injected into the sac that encircles the ovaries protected the ovaries from lethal doses of radiation. The mice remained fertile, eventually producing normal offspring, which continues to be monitored by the team. The promising results will be repeated in non-human primates before a clinical trial can be conducted on women.

A second major area of inquiry for researchers interested in preserving fertility in cancer patients is freezing fertilized human eggs and then doing in vitro fertilization (IVF), which involves hyperstimulating the ovaries with high-dose hormones and harvesting many eggs for fertilization in the lab. The embryos are then frozen so they can be implanted in the uterus in the future. Dr. Petrek cautions that a cancer patient who chooses a course of IVF should immediately undergo chemotherapy to counteract the potentially dangerous effects of high-dose hormones on tumor tissue.

According to Dr. Petrek, chemotherapy drugs that are easier on the ovaries include methotrexate and 5-flourouracil. More damaging to the female reproductive system are the drugs cyclophosphamide and melphalan. Tamoxifen causes menopausal symptoms, hot flashes and vaginal dryness, for example, however these are reversed when the medications are stopped.

The Lupron Solution
One of the most intriguing experimental treatments to date involves treatment with a common fertility drug, GnRH-a, a drug used to shut down the ovaries and slow egg development during a specific phase of infertility treatment. Some doctors have been offering the drug to women undergoing chemotherapy as a way of preserving a woman's limited egg supply. These physicians posit that arresting or slowing egg development makes the eggs less likely to be damaged or killed by chemotherapy.

Dr. Zeev Blumenfeld, an Israeli researcher, is the leading expert on GnRH-a therapy. The reproductive endocrinology researcher is conducting an on-going investigation at Technion-Israel Institute of Technology in Haifa. The most promising results, which were released last year, showed that of 44 women undergoing chemotherapy all but one of the patients on a GnRH-a regimen had normal menstrual cycles within six months after stopping the drugs. Blumenfeld's study, reported in The Journal of the Society of Gynecologic Investigation last year, found that fewer than half the women who did not receive GnRH-a had normal menstrual cycles.

In a recent interview in the New York Times, Dr. Blumenfeld said that 94 percent of the women he's treated have regained ovarian function and that 13 of the 44 women originally enrolled in his study have become pregnant, bearing eighteen babies. Dr. Blumenfeld surmises that GnRH-a may also reduce the blood supply to reproductive organs, in turn reducing the amount of chemotherapy directed to the ovaries.

Dr. Edward Trimble, MD, head of the surgery section at the National Cancer Institute's Cancer Therapy Evaluation Program, is following the Lupron studies with equal measures of interest and caution. Trimble's team assists researchers conducting clinical trials with funding and expertise. "In any given year approximately 20,000 patients are enrolled in clinical trials organized or sponsored by the NIH's cancer therapy evaluation program," says Dr. Trimble.

While the NCI's Cancer Therapy Evaluation Program is not currently funding research into GnRH-a therapy Trimble says he's aware of the anecdotal accounts and the few trials that report it can successfully preserve the fertility of women undergoing cancer treatment. "We don't have enough data yet on GnRH-a. And it's not been approved by the Food and Drug Administration for this use, but we're interested in any scientific attempt to improve the lives of cancer patients," says Dr. Trimble. Even without the FDA's blessing, fertility and cancer experts report that many doctors are offering GnRH-a to their patients.

Clearly, the future is brighter than it has ever been for survivors who want to preserve their chances of bearing children. And clearly, any woman recently diagnosed with breast cancer must carefully discuss with her doctor the treatments which are most likely to preserve fertility. "The different therapies have different side effects, of course," Dr. Petrek says. "But if having children is essential, always let your oncologist know." Elissa Wolf-Tinsman is glad she did. And her child Story will have some tale to tell.