Early in his career as a medical resident, Dr. Tommaso Falcone heard a familiar refrain almost anytime a young woman was diagnosed with cancer: Will I be able to conceive after completing treatment?
It was a question posed regardless of how dire the diagnosis.
“These women were facing a severe disease,” says the 62-year-old Montreal native who arrived at the Cleveland Clinic 21 years ago as head of reproductive endocrinology and infertility and now chairs its Women’s Health Institute. “But for them to have hope that they’re going to have a normal life, fertility is part of that.”
Fostering that goal moved Falcone to specialize in preserving their fertility.
Falcone was part of the team that performed the nation’s first uterus transplant at the Cleveland Clinic earlier this year, although it was ultimately unsuccessful.
But Falcone’s greatest interest lies in a still-experimental procedure originally developed by British scientist Roger Gosden. The procedure involves removing ovarian tissue from a patient with cancer and freezing it. After the threat of damage or destruction from chemotherapy and/or other drug treatments has passed, the tissue is thawed and returned to the body.
Ovarian tissue preservation is part of a fertility preservation program Falcone started seven years ago at the Clinic, which is still one of the few places in the nation where it’s available. He says the major advantage the procedure offers over standard alternatives — particularly the freezing of embryos created via in vitro fertilization — is speed.
“IVF takes time,” he says. “It takes a couple of weeks. I can [remove an ovary] Monday morning, and [the patient] can start her chemotherapy Monday afternoon.”
The process generally involves removing one ovary. The second ovary is left in the body because in breast cancer patients there’s about a 40 percent chance it will emerge from drug treatment unscathed.
In some cases, drug treatments are not deemed toxic enough to endanger fertility and only a portion of the ovary is removed for freezing. “This is like an insurance policy,” Falcone says.
Freezing the ovary after surgery isn’t as simple as it may sound. Tissues with a high water content generally don’t freeze well. The water expands and ruptures cell walls, just like ice-filled pipes in a crawl space on a subzero day. While the ovary itself is low in water, the resting eggs inside are filled with it. So doctors remove as much water as possible and replace it with a drug that lowers the freezing point.
Falcone compares the result to the Alaskan wood frog that freezes solid in the winter and thaws in the spring to live another year. “Its blood has a chemical that is like an antifreeze,” Falcone says. “That antifreeze prevents the damage.”
The ovary begins to function normally three months after it is returned to the body.
According to Falcone, 60 babies have been born to patients who have chosen to safeguard their fertility with ovarian tissue preservation, most of them in Europe. None have been born at the Clinic yet because the process of transplanting the ovaries back into the body can’t take place until five to six years after treatment is complete.
The first Clinic patients to opt for ovarian-tissue preservation just finished that wait within the last year.
“They don’t want to be just alive, they want a quality of life associated with being alive,” he says. “Fertility is an important quality of life for women of reproductive age.”