From the left, Aimee Seungdamrong, director of fertility preservation at University Reproductive Associates (URA); Sara Morelli, director of the Division of Reproductive Endocrinology and Infertility at Rutgers New Jersey Medical School (NJMS) and a physi

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From the left, Aimee Seungdamrong, director of fertility preservation at University Reproductive Associates (URA); Sara Morelli, director of the Division of Reproductive Endocrinology and Infertility at Rutgers New Jersey Medical School (NJMS) and a physician at URA; and gynecologic oncologist Karen Houck, an associate professor of obstetrics, gynecology, and women’s health at NJMS.

Photography: 
John Emerson

After developing vaginal bleeding so severe that she was hospitalized and given transfusions, 37-year-old Sachi Gupta was diagnosed with a fibroid tumor. Forced to wait two years because she lacked health insurance, she finally underwent a dilation and curettage, a procedure to diagnose and treat uterine disorders. It revealed she had endometrial cancer, which starts in the uterine lining. Despite the delay in treatment, with care, including a hysterectomy, she had an excellent chance of recovery. Gupta was referred to gynecologic oncologist Karen Houck, an associate professor of obstetrics, gynecology, and women’s health at Rutgers New Jersey Medical School (NJMS), who told her there were ways to preserve her fertility.

Can a woman without a uterus actually have a child? Yes, thanks to advances in oncofertility, a field that combines research in oncology and reproductive endocrinology to maximize cancer survivors’ reproductive potential. Cancer treatments, including surgery, chemotherapy, and radiation, leave many patients unable to have children following a successful recovery. Approximately 10 percent of those diagnosed with cancer are under age 40, affecting 130,000 people a year in the United States.

As cancer treatments improve and survivorship increases, the ability to have children is an important concern, says reproductive endocrinologist Sara Morelli. She is director of the Division of Reproductive Endocrinology and Infertility at NJMS and one of eight physicians at University Reproductive Associates (URA), a clinical practice providing the latest treatment options to maximize and preserve fertility. “We’re seeing more cancer patients who want to preserve their fertility,” says Morelli. “Men undergoing cancer treatment can have semen samples frozen for future use. In women, solutions are a bit more complex. Thankfully, oncologists are increasingly aware of this highly specialized work.”  

Infertility is defined as 12 months of trying unsuccessfully to conceive. In individuals 35 years of age and older, this time is reduced to six months. It has many causes, including problems with sperm, ovulation, or Fallopian tubes. “About 30 percent of infertility is unexplained,” says Morelli, who also directs the reproductive endocrinology and infertility fellowship program at NJMS. “Simple ovulation disorders can be corrected with medicine. Other couples require more advanced therapy, such as insemination or in vitro fertilization. In couples where the male has a severely low sperm count, we can inject a sperm right into a mature egg.”

Pregnancy becomes more complicated when reproductive organs are affected by cancer. In Gupta’s case, imaging showed potential for invasion into the uterine wall, so there was no time to waste. Following injections to stimulate the production of eggs, Gupta underwent egg retrieval, performed by Aimee Seungdamrong, director of fertility preservation at URA. Eggs are aspirated vaginally via an ultrasound-guided needle led through the vaginal wall into the ovary. Two of Gupta’s eggs were retrieved and fertilized with her husband’s sperm. Later, Houck performed a minimally invasive hysterectomy. A patient with Gupta’s cancer would typically lose her ovaries as well, but Houck was able to leave them in for now so that Gupta may undergo another egg retrieval.

“It’s not a tremendous number, but I’m thrilled to have two healthy embryos,” Gupta says. In vitro fertilization is expensive, but many foundations provide funding to patients with cancer. Embryos can be kept frozen indefinitely. Once Gupta’s cancer treatment is finished and she is ready to start a family, URA will guide her through the complex process of finding a gestational carrier.

Gupta’s prognosis is good and she recently returned to work. “I’m dealing with cancer but this gives me hope,” she says. “To have my own baby means everything to me.”