The Dr Dorothea Sandars Churchill Fellowship to develop cutting edge oncofertility options for Australian females

Project Description: Advances in oncology have resulted in increased survival rates following cancer therapy. Consequently, there is an increase in the number of female cancer survivors aspiring to have children later in life. Unfortunately, cancer treatments such as chemotherapy often cause infertility. Loss of fertility is one of the most distressing realities for cancer patients. Oncofertility is an established field that comprises care from both cancer and fertility health care providers. Australia is about a decade behind the Northern Hemisphere for providing cancer survivors a continuum of care from first diagnosis to successful fertility preservation which culminates in childbirth. One of the contributing factors to Australia’s sluggish uptake is the absence of robust fertility preservation strategies that capture the full reproductive potential of cancer patients.  The objectives of my Dr Dorothea Sandars Churchill Fellowship were to: Understand the challenges of current fertility preservation strategies. Assess how improvements can be made in current fertility preservation. Propose where current international strategies can be integrated to increase success.  Bring Australia’s first dedicated oncofertility clinic, the Fertility & Research Centre, closer to the global Oncofertility Consortium network. Establish collaborations with world-leaders in the field of fertility preservation and drug development.  This report will include an overview of the state-of-the-art in fertility preservation and will address the objectives of the Fellowship. Potential avenues of research are suggested to improve the success of fertility preservation.  Highlights: Undertaking training in a globally leading research laboratory. Meeting world-leaders in fertility research. Establishing collaborations with groups at Northwestern University and Harvard Medical School.   Recommendations: The impact of infertility on cancer patients requires strategic focus by national cancer and fertility specialist organisations across Australia to address concerns of patients.  Lobby governments to increase funding for basic research into ovarian biology and female fertility. Funding of basic research into reproductive biology is absolutely a rate-limiting step in Australia. American labs are fortunate in that they have a large philanthropic network as a source of non-governmental funds – we do not have those kinds of resources in Australia making researchers profoundly more reliant on government funding.   To address the current knowledge gap in understanding oocyte (egg) quality, research programs need to address the molecular and cellular processes that confer the ability of oocytes to form healthy offspring.  To address the knowledge gap in preserving the number of oocytes in ovaries either during cancer therapy or during fertility preservation procedures, research programs need to address the molecular and cellular processes that regulate ovarian follicle activation and what maintains quiescence of the ovarian follicle pool.    Once effective fertility preservation strategies are established, well-defined oncofertility referral pathways should be developed between cancer centres, psychologists and fertility clinics to ensure that all patients have adequate and prompt access to oncofertility services.  While learning of cancer illness and potential infertility can be a challenging time for patients, clinicians should encourage patients to donate tissue for research when possible. Donation of reproductive tissues occurs during fertility preservation procedure and will significantly advance the research of scientists in the field.    Keywords: Antrum, cytoplasmic maturation, DNA, ECM, Gonadotrophins, In situ, In vitro, In vivo, IVF, IVM, FSH, LH, Meiotic maturation, methylation, NAD, oncofertility, oocyte, ovarian follicle, OTC, revascularisation