Madeleine van der Perk is a physician researcher in the research group of Prof. dr. Marry van den Heuvel-Eibrink and investigates how to improve the fertility care of girls with cancer who are being treated at the Máxima Center. The PAREL study (acronym in Dutch: patients timely information about fertility and the safety of ovarian tissue freezing as fertility sparing treatment in a national pediatric oncology center) evaluates whether the fertility care plan is effective and feasible in practice. 'We want to avoid a situation where a woman only finds out later that she can no longer get pregnant because of the treatment she received as a child,' says the physician researcher oncofertility.
Ovarian tissue
Girls who survive cancer can enter menopause early. Particular chemotherapy and radiation to the lower abdomen can cause damage to the eggs. Madeleine van der Perk: ‘Immediately after the diagnosis, the ova or ovarian tissue can be frozen. Should the girl have a desire to have children later in life, this tissue can be put back.' The developments of this are hopeful: 'Worldwide, almost 300 girls under the age of 13 have been reported to have had ovarian tissue frozen. Of these, 16 have also had ovarian tissue returned and nine healthy children have already been born.'
Fertility Care Plan
The initial emphasis with cancer is often on diagnosing and starting the best treatment. 'The later effects are not always directly addressed. However, measures to preserve a girl's fertility should be taken as soon as possible after the diagnosis. That's why, together with the other colleagues in the onco-fertility team, we set up a standard fertility care plan in 2015 to ensure that all girls get the same care and information around fertility.' The care plan consists of 5 steps: 1) rapid identification of each new patient, 2) early triage of risk of ovarian damage, 3) personalized information provided, 4) in the case of the girls with an increased risk, referral to the gynecologist for counseling and 5) discuss options for fertility preservation there,' says Madeleine.
Effective
Even if there is a low risk of early menopause, this is discussed. 'Because many parents worry about this at the time of diagnosis,' says van der Perk. 'We know that parents and children are better able to deal with the consequences later if they are involved in the decision-making process, regardless of which choice they have made.'
Madeleine van der Perk is also investigating the safety of the laparoscopic procedure. 'We also want to investigate whether cancer cells are present in the ovarian tissue, which can happen if you freeze the tissue before starting cancer treatment. With in vitro maturation (IVM), important steps are being taken to be able to circumvent that, but we are not there yet. In addition, in a European context, we have been investigating genetic factors with colleagues from the United States that may play a role in a girl's risk of infertility.'
Read the detailed interview with Madeleine