41 timestamped statements
across 2 topics
— auto-found in recorded discussions, each timestamp jumps to the exact moment.
Summaries Hefkin gave as host are listed separately below.
Featured statements
▶Ep 1 · 25:40
The difference with doing ovarian tissue cryopreservation is you may be then doing an oophrectomy on a 1 month old or a 2 month old. That's usually where most of my adult colleagues will say it's not really where I am trained and that's not really where my comfort level is.
Oocyte cryopreservation was made standard of care by the Society for Reproductive Medicine in 2012, removing barriers for adolescents who previously required long-term partners or sperm donation for embryo cryopreservation.
Keys to Building a Successful Interdisciplinary Program-Creating the...
▶Ep 2 · 0:22
opinionThe biggest thing that is important in doing a fertility preservation program is having a collaboration of multidisciplinary providers from both the medical and surgical aspects of the patient's care including oncology, surgical aspects, and primary care physicians.↗
▶Ep 2 · 0:40
quotethe biggest um thing that is important in doing a fertility preservation program is having a collaboration um that of multidisciplinary providers↗
▶Ep 2 · 1:20
clinicalAncillary care team members including care managers from oncology, patient navigators from the fertility team, social work, psychology, genetics, and ethicists help optimize decision making and final outcomes.↗
▶Ep 2 · 3:00
opinionThe fertility navigator role is one of the most important steps in the consultation workflow.↗
clinicalTwo oncologists work as part of the fertility preservation program and perform risk assessments instead of the primary oncologist.↗
▶Ep 2 · 4:00
clinicalThe oncologist on the fertility team provides risk assessment information to either the gynecologist or urologist depending on whether the consultation is for a male or female patient.↗
▶Ep 2 · 5:20
clinicalResearch coordinators assist with experimental fertility preservation techniques.↗
▶Ep 2 · 6:00
guidelineThe program has a motto that every patient should receive a fertility preservation consultation regardless of their risk.↗
▶Ep 2 · 6:05
quotewe have a motto here that every patient should receive a fertility preservation consultation regardless of their risk↗
▶Ep 2 · 6:20
clinicalFamilies need to understand why different patients receive different fertility preservation options, which may be due to differences in risk or age.↗
▶Ep 2 · 6:25
quoteif the person next door was offered this option and my son wasn't offered this option, why is that?↗
▶Ep 2 · 7:00
clinicalPatient decision aids and shared decision-making tools guide families through the decision-making process by explaining available options, time frames, risks and benefits, and costs of different procedures.↗
▶Ep 2 · 7:30
clinicalThe shared decision-making tools include considerations such as ethical considerations, religious considerations, genetics, and social services.↗
▶Ep 2 · 7:50
clinicalThe shared decision-making tools are available for use at other centers.↗
▶Ep 2 · 8:00
clinicalEducational videos provide a brief introduction to fertility preservation that families can watch prior to consultation.↗
▶Ep 2 · 10:05
clinicalThe program has a dedicated website not housed in any of the participating disciplines where patients, families, and providers can find information about the program and how to consult the team.↗
Ethical Considerations in Pediatric Fertility Preservation: Pediatric...
▶Ep 1 · 23:00
opinionA hub-and-spoke model is proposed where large centers with fertility preservation programs provide consultation and resources to smaller centers, with patients traveling to the hub for experimental procedures requiring specialized expertise.↗
▶Ep 1 · 25:22
clinicalMost adult gynecologists are comfortable doing adolescent gynecology, but the discomfort comes with how young a patient they are comfortable operating on; ovarian tissue cryopreservation may require oophorectomy on a 1-2 month old infant.↗
▶Ep 1 · 25:40
quoteThe difference with doing ovarian tissue cryopreservation is you may be then doing an oophrectomy on a 1 month old or a 2 month old. That's usually where most of my adult colleagues will say it's not really where I am trained and that's not really where my comfort level is.↗
Hefkin's statements about Pediatric Oncology21 statements
Options for Female Fertility Preservation: Pediatric Oncofertility 2017
▶Ep 60 · 2:22
guidelineOocyte cryopreservation was made standard of care by the Society for Reproductive Medicine in 2012, removing barriers for adolescents who previously required long-term partners or sperm donation for embryo cryopreservation.↗
▶Ep 60 · 5:00
epidemiologicalLive birth rates for embryo and oocyte cryopreservation average 33-52%, with oocyte outcomes approaching embryo outcomes due to improved freezing and thawing techniques.↗
▶Ep 60 · 5:50
clinicalControlled ovarian stimulation for oocyte/embryo cryopreservation historically required 4-6 weeks, but recent luteal-phase protocols can achieve consultation to cryopreservation in less than 2 weeks.↗
▶Ep 60 · 7:30
quoteConnecticut is now the first state who, um, does have, uh, mandated fertility preservation coverage for, uh, fertil for patients. The way that they did this was they changed the definition of fertility, so instead of previously where the definition of fertility and I wanna get this right was um to look at otherwise healthy females, right? And so you looked at healthy females who had tried to um try for fertility for 6 months to 12. Months and were unable to get pregnant, they took that language out and they changed it to medical necessity.↗
▶Ep 60 · 7:30
guidelineConnecticut is the first state with mandated fertility preservation coverage, achieved by changing the definition of infertility from 'otherwise healthy females trying for 6-12 months' to 'medical necessity.'↗
▶Ep 60 · 10:50
clinicalOvarian transposition achieves 50-90% reductions in radiation to the ovary and 30-50% maintenance of ovarian function, but fertility preservation outcomes are not well studied in pediatric populations.↗
▶Ep 60 · 14:10
epidemiologicalThree breast cancer studies showed GnRH analogs decreased amenorrhea, while three lymphoma studies showed no protection in ovarian reserve, with two studies stopped early due to lack of benefit.↗
▶Ep 60 · 15:00
guidelineIn 2013, ASCO guidelines recommended that patients be informed there is insufficient evidence to recommend GnRH analogs as fertility protection.↗
▶Ep 60 · 15:50
clinicalThe POEMS study (Prevention of Early Menopause Study) in breast cancer patients using goserelin plus chemotherapy versus chemotherapy alone showed statistically significant reduction in ovarian failure and decreased odds ratio for pregnancies.↗
▶Ep 60 · 17:30
clinicalOvarian tissue cryopreservation is the only method of fertility preservation available for prepubertal patients.↗
▶Ep 60 · 18:20
clinicalCincinnati Children's ovarian tissue cryopreservation protocol allows females ages 1 month to 41 years undergoing gonadotoxic treatment, with FSH less than 20, and no restrictions based on risk assessment (though most patients electing OTC are high-risk).↗
▶Ep 60 · 19:10
clinicalCurrent cryopreservation standard is slow-freeze technique; vitrification studies show it is likely better, but it should not be considered standard until outcome data exists.↗
▶Ep 60 · 20:00
epidemiologicalCincinnati Children's has performed over 70 ovarian tissue cryopreservations with 4 complications (3 minor, 1 small bowel obstruction 1 year post-procedure in patient with bowel GVHD), 5 deaths (9.6%, all disease-related, none procedure-related), and no complications since the 52-patient review.↗
▶Ep 60 · 20:50
epidemiologicalThere have been 86 live births in the literature from orthotopic ovarian tissue transplantation, with 2 from patients in the prepubertal population (only 1 reported in literature).↗
▶Ep 60 · 21:40
epidemiologicalIn the Jadoul study of 545 ovarian tissue cryopreservation procedures, there were only 5 minor complications, 1 major complication requiring repeat surgery for bleeding, and only 1 death reported in all literature from OTC procedures.↗
▶Ep 60 · 22:30
epidemiologicalIn the Jadoul study, 30% of patients were under age 18 and 15% were prepubertal, with a deceased rate of 10% overall and 13.5% in patients under 18.↗
▶Ep 60 · 22:40
epidemiologicalTissue utilization rate in the Jadoul study was 4%, compared to less than 10% for oncology patients who return to use cryopreserved semen.↗
▶Ep 60 · 22:50
epidemiological96% of patients surveyed were satisfied with having undergone ovarian tissue cryopreservation, including those who did not utilize their tissue, showing satisfaction comes from having the choice rather than needing to use it.↗
▶Ep 60 · 22:50
quote96% of the patients who they surveyed said they were satisfied with the fact that they had this procedure. And that included the patients who did not end up utilizing their tissue, so even the patients who gave their tissue back to research or discarded their tissues still had an overall satisfaction with having the procedure done, um, basically showing that it's the idea of having the choice, um, more than whether or not they ended up needing to utilize their tissue.↗
▶Ep 60 · 23:42
quoteI've never once felt that it was my place to make that suggestion to the patient.↗
▶Ep 60 · 29:11
clinicalIn prepubertal patients, it is technically difficult to remove cortical strips from already very small ovaries, which is why some institutions remove whole ovaries in younger patients while adult centers typically remove cortical strips from larger ovaries.↗
Summaries Hefkin gave as host
· 8 summaries
Recaps of what the experts said, with Hefkin as narrator — not Hefkin's own clinical position, and never cited in answers.
Keys to Building a Successful Interdisciplinary Program-Creating the...
▶Ep 2 · 8:20
host summaryHefkin summarizing a resource: The body's sperm and egg cells are vulnerable to cancer treatment.↗
▶Ep 2 · 8:40
host summaryHefkin summarizing a resource: Most people start from birth with the ability to have children.↗
▶Ep 2 · 8:50
host summaryHefkin summarizing a resource: The fertility preservation team consists of a fertility navigator, a pediatric oncologist, a pediatric gynecologist for girls, or urologist for boys.↗
▶Ep 2 · 9:05
host summaryHefkin summarizing a resource: For young children, the choice to undergo fertility preservation lies with the parent or guardian, but teenagers and young adults can help make the decision after learning all the facts.↗
▶Ep 2 · 9:20
host summaryHefkin summarizing a resource: Four factors determine procedure options and risk of infertility: chemotherapy type and dose, patient age, timing of cancer therapy, and patient sex.↗
▶Ep 2 · 9:35
host summaryHefkin summarizing a resource: As patients get older, their risk of infertility increases, and there are more procedure options once a patient has gone through puberty.↗
▶Ep 2 · 9:45
host summaryHefkin summarizing a resource: For boys, fertility preservation options include freezing sperm cells or testicular tissue; for girls, options include freezing eggs, embryos, or ovarian tissue.↗
▶Ep 2 · 9:55
host summaryHefkin summarizing a resource: Cryopreservation is the process of freezing cells at an extremely cold temperature, and the cells can be stored for up to years at a time until they are needed.↗
