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Polly Melville
Polly Melville was diagnosed with cancer at 14. Photograph: Sophie Gerrard/The Guardian
Polly Melville was diagnosed with cancer at 14. Photograph: Sophie Gerrard/The Guardian

'It gives you hope': the fight to save the fertility of children with cancer

This article is more than 5 years old

Young cancer patients face uncertainty, aggressive treatment – and a risk to their future fertility. Can a cutting-edge procedure offer a solution?

It started with a cough. Polly Melville was 14 years old, an athletic schoolgirl living just outside Tain in the Scottish Highlands. She had always felt fit and healthy, but was now struggling to fight off what seemed like a chest infection. She lost weight. Her lymph glands were terribly swollen. After months of tests, she was given a devastating diagnosis: she had Hodgkin lymphoma, a type of cancer.

For four-year-old James, it began in April last year, with a headache. Within a month, the pain was so bad that he was punching his head to make it go away. His GP thought it might be childhood migraines. Then scans revealed a large brain tumour at the back of his skull. A neurosurgeon explained to James that there was a black ball in his head, and they were going to take it out. “So I won’t have a sore head any more?” his mother, Lynne, recalls him asking. “Oh yes, high five!”

Polly’s cancer, which she and her sisters came to call “Mr Hodgkin”, went into remission after six months of chemotherapy. Slowly, she felt better. But then it returned. She needed more chemo, and this time it would be more aggressive. So aggressive, in fact, that her doctors expected it to leave her infertile. She was likely to go into menopause soon after her treatment, experiencing the hormonal changes, hot flushes and chronic pain that women usually confront in their 50s.

James also needed more treatment. First radiotherapy: five days a week for six weeks, each time under full anaesthetic. Then chemotherapy. “I’m going to cover you with my hair!” he joked to his sisters. When all that was over, there would be another side-effect. Like Polly, he was likely to be infertile.

The hope of conceiving a child some decades from now may seem insignificant compared with the immediate challenge of surviving a terrible disease. But it is precisely because doctors have become so much better at treating children with cancer that they are paying more attention to the future. In the 1970s, only about a third of children survived the disease beyond 10 years. Now it is roughly three-quarters, and the rate keeps improving. The five-year survival rate, which reflects the most recent advances in treatment, is more than 80%.

Prof Hamish Wallace, a paediatric oncologist in Edinburgh, has witnessed the huge change in his field. On a bright summer morning, we meet in the cosy old townhouse by the Meadows, where he has been treating children with cancer since the 1990s. There are flowering shrubs outside and a football table in the waiting room. A nappy-changing table in the corridor is a reminder of just how young some of his patients are. In his office, stuffed toys are piled up by the examining bed, and the walls are covered with photos of his former patients celebrating life’s milestones: smiling children on holiday, proud graduates in black gowns, happy couples on their wedding day.

Wallace recalls a time when the outlook for these young patients would have been grim. Take leukaemia, he says, the most common type of childhood cancer. In the 1960s, when he was a little boy in Edinburgh, there was no hope: “You’d have brought a pale child with bruising, bleeding and maybe infection to the hospital, they’d have a blood test and a bone marrow test, a diagnosis of leukaemia would be made, and the only treatment available at the time was a metal canula and a blood transfusion. And it was considered to be a death sentence.” He shakes his head in wonder. “Now, we expect to cure 90% of children with leukaemia. That’s happened in our lifetime. It’s amazing.”

But as more and more children and teenagers recovered, doctors were faced with a new challenge. They saw children who bravely endured chemotherapy, radiotherapy and multiple surgeries, only to be crushed by the long-term side-effects. One of them was infertility. Certain types of chemotherapy can kill eggs, sperm and even the so-called germ cells in a little boy’s testicles that would later develop into sperm. Radiotherapy can indirectly affect fertility by disrupting hormone production. It can also damage the ovaries, womb and testicles.

“Just to cure children isn’t enough,” Wallace says. “If you cure them and they are stunted in growth, intellectually not achieving their potential, and infertile, then perhaps you haven’t achieved enough.” Earlier this year, a study he co-authored showed that women who have survived cancer are 38% less likely to become pregnant compared to the general population.

“I’ve looked after children who were successfully being cured, and then I’ve witnessed what happens in their teenage years when they then go through premature ovarian failure,” says Dr Sheila Lane, a paediatric oncologist at the John Radcliffe hospital in Oxford. “Suddenly their cancer now lives with them for ever.”

As she shows me around the sprawling hospital complex where she works, Lane describes the damage that infertility can inflict on a young person. I later hear what she tells me echoed by several survivors: the fear that nobody will love them, the feeling of being somehow deficient. Infertility can be difficult at any age, but for someone who is only just starting to discover themselves and form relationships, it can be devastating. Lane decided she had to help. In 2013, she and her colleagues set up a service in Oxford offering fertility preservation for young patients. This new, fast-evolving science uses cryopreservation – the process of freezing tissue – to enable a person to have children in the future.

Adults threatened with infertility from cancer treatment can freeze eggs or sperm if there is time and their hospital offers it. But how do you save the future fertility of a child, or even a baby? A girl has all the eggs she will ever have by the time she is born, but those eggs are immature. And little boys do not yet produce any sperm.

A team of scientists in Edinburgh found the solution, or at least part of it, in the 1990s. Instead of having to harvest individual, mature eggs, you could freeze an entire piece of ovary with all the eggs in it, stitch it back later, and hope it would spring back to life. They tried this in sheep, and it worked: the result was a healthy little lamb called Elmar.

Dr Rod Mitchell places tissue samples from boys’ testicles in liquid nitrogen for cryopreservation. Photograph: NHS Endowments Trust

“People had done some crazy ovarian transplants over the years, going back a hundred years, actually,” says Prof Richard Anderson at the University of Edinburgh, who helped set up the pioneering fertility preservation service there. “But [the Edinburgh team] really thought that this would be something that could be done for cancer patients.”

The team started freezing ovarian tissue from adult women, teenagers, children, and even babies. The tissue is collected while the patient is under general anaesthetic. If possible, this is combined with a procedure that is part of the cancer treatment, such as a biopsy. In the case of girls and women, either a piece of the ovary or one whole ovary is removed through keyhole surgery. The ovary’s outermost layer, which contains the eggs, is then cut into strips, frozen and stored at about -170C using liquid nitrogen vapour.

Around the world, other scientists did the same, freezing and storing tissue from adults and children. And then, in the 2000s, they began to transplant it back.


Sara Matthews, a consultant gynaecologist at the private Portland Hospital for Women and Children in London, still remembers the day about three years ago when a young woman called Moaza Al Matrooshi walked through her door. At first, her story sounded like that of many other women: she had recently married, and was struggling to conceive. But when Matthews leafed through Moaza’s medical history, she noticed something unusual. At the age of nine, Moaza had undergone chemotherapy as part of her treatment for beta thalassaemia, a blood disorder. Before the treatment, one ovary had been removed, cut into pieces and frozen at the University of Leeds. Moaza was now in her early 20s and undergoing menopause. Her only viable eggs were in that frozen tissue in Leeds. No one had ever reimplanted tissue taken from such a young girl and stored for such a long time: 14 years. But Matthews thought it was worth a try.

Together with specialist surgeons in Denmark, Matthews stitched the preserved tissue back into place, a procedure she describes as straightforward. They removed the skin from Moaza’s remaining ovary, made “a little patchwork quilt of new pieces where the old skin was”, and tucked the remaining pieces into the fold of tissue where the other ovary had been, “like a little sandwich”.

A young girl’s – and indeed a baby’s – ovaries contain hundreds of thousands of eggs. So there was a good chance that the tissue would work as well as, or even better than, tissue from older patients whose reserve has already declined. Nevertheless, what Matthews was doing was unprecedented, and she knew that she and her patient would attract global attention.

“I said to her, ‘We’re going be on the news, if this is going to work… Are you OK with that? Because this means so much to so many little girls.’” Matthews’ voice breaks as she says this, and she stops. “Sorry, I get very emotional about these things.”

A few months after the operation, both the little patchwork and the little sandwich were producing eggs. The frozen pieces had sprung to life again. The eggs were fertilised through IVF, and one of the resulting embryos grew in Moaza’s womb. Nine months later, she gave birth to a healthy baby boy. As Matthews had predicted, the birth made headlines around the world. It remains an extraordinary case. More than a hundred babies have been born from ovarian transplants worldwide. But Moaza is still the only person in the world to have had a baby from tissue collected before puberty.


For Polly Melville, saving her fertility was the last thing on her mind as she faced a new round of treatment. But her mother, Susie, worried about it. “For her to deal with that knowing she would never give birth to her own child was just so cruel.” Polly’s sisters joked that they could have a baby for her, and they all giggled about it. Susie feared that the reality would be more painful.

It was then that Polly was referred to Wallace in Edinburgh. He mentioned this groundbreaking procedure, which sounded rather surreal to her: his team could take a strip of her ovary and put it in a freezer, and in 10 or 20 years, they could stitch it back and hope it would help her have a baby. Polly found the idea a bit abstract, but she said yes. “I thought it was just another operation – like, four extra scars, but I’m covered in them anyway. So it wasn’t a big deal.”

But Susie noticed something else about the doctor’s offer. This wasn’t about chemo, about scans, about getting through the next day. This was about life after cancer. “I thought to myself, they wouldn’t be doing this if there was no hope for Polly. They wouldn’t be wasting resources.”

The tissue was taken while Polly was already under general anaesthetic for a biopsy. She completed her treatment, recovered, and gradually rebuilt a normal life in Tain. Then she fell in love. It was her first relationship, and it made her think about the future, about children. Remembering her frozen piece of ovary, she felt relieved: “I was like, that’s something to fall back on if it doesn’t happen naturally. So it wasn’t until I got better that I did really think about it, and think how much I appreciate them doing that for me.”

James was also offered the chance to store tissue. But there was a crucial difference between his situation and Polly’s. Women have had healthy babies thanks to ovarian tissue transplants. There has been no equivalent success with transplanted pieces of testicle. The only option for little boys like James is to bank tissue in the hope of a future solution, with a small part used for research. Surgeons remove up to half of one of the testicles, which is then frozen. After this, the testicles are expected to continue to grow normally. Because James was so young, his mother, Lynne, ultimately had to decide whether to put him through this process. “It’s only maybe in the last five years that people have really started to think about the boys in terms of the impact on their fertility,” says Dr Rod Mitchell, a paediatric endocrinologist at the Royal Hospital for Sick Children in Edinburgh.

I visit Mitchell at the lab where he is leading a new research project on fertility preservation for boys. On the walls are posters of testicular tissue under a microscope, in psychedelic colours. “One big step for man… capturing the moment when a testis forms”, a caption reads. A scientist in a white coat is preparing samples to be studied. Funded by a European Union grant and a charity, Children with Cancer UK, the lab is the only one of its kind in the UK.

Mitchell is chatty and enthusiastic, but also clear about the tremendous responsibility that he and his colleagues carry. They are proceeding very carefully, aware of how precious the human samples they are working with are, and how much hope they represent to patients and their families.

“One of the key things for us is that it is still research, and it is still experimental,” he says. “So while we know we can store the tissue from them, we have to make it very clear that we don’t have a way in which we can use the tissue to restore their fertility just now.”

Mitchell slides a purple-stained tissue sample from a young boy under a microscope and offers me a look. I can see immature germ cells, and cross-sections of small coiled tubes, part of an intricate network through which the sperm will eventually travel. A successful transplant would involve reconnecting all these tubes, something that is currently not possible. One alternative solution might be to mature the germ cells in a Petri dish – essentially, to grow sperm in the lab. Another is to transplant the tissue in the hope that the cells in it will mature into sperm, even if the tubes cannot be connected. The sperm could then perhaps be harvested and used in IVF.

Mitchell is cautiously optimistic: “Our strong expectation is that by the time they come to need it, which might be in 10, 15, 20 years’ time, that we will potentially have an option for them.”


At the hospital in Oxford, I watch two technicians prepare tissue for storage behind a glass window, framed by balloons from a leaving party. The youngest girl to have had her tissue banked here was nine months old. The youngest boy, only four months.

“This isn’t about shoving tissue in the freezer,” Lane says. “It’s about giving people options, and walking the path with them.” She emphasises the importance of explaining the procedure to young patients as far as possible; she might, for example, compare it to a piggy bank. In her experience, children are curious about science and do not shy away from questions. One boy asked her what would happen to his tissue if he died. She explained that he had a choice: it could either be donated to research or it could be destroyed.

Polly Melville thought she was infertile after cancer treatment at 14, but then became pregnant with Ruby at 18. Photograph: Sophie Gerrard/The Guardian

The programme is a collaboration between the University of Oxford and the NHS, with the majority of funding coming from donations. Her own children have chipped in, baking cakes, running a marathon and cycling the length of Britain to raise money for a dedicated fund, the Future Fertility Trust. The service has grown quickly, and now banks tissue from almost 500 girls and almost 200 boys; each sample will be kept for up to 55 years. From 2020, the costs will be covered by the NHS.

James’ mother, Lynne, thought carefully about the best choice for her son, who had already been through so much. She felt she owed it to him to agree. “This may be his only chance to be a natural father in 20 years’ time, and I couldn’t not give him that chance.”

She explained the process to James in simple terms, saying it was to see if he could have babies when he was older. It would be carried out while he was already under general anaesthetic for another procedure, to minimise the strain. “That’s fine,” James replied.

Fertility preservation is about the future. But when I speak to survivors of childhood and teenage cancer, I am struck by how much it is also about the present, about how they feel about themselves right now.

Kate Dobb was diagnosed with cancer in the late 1980s, when she was 10 years old. Two years of treatment left her infertile. No one talked to her about this; people just seemed surprised she was still alive. Kate, a self‑professed science geek, figured it out at the age of 12 from her doctor’s comments about hormone replacement therapy. She was devastated: “That whole future that you imagined you might have had, is completely taken away from you.”

The treatment had been gruelling, but at least it was over. Infertility was there to stay. She could not see why anyone would want to be with her, and shied away from relationships. Her interest in science led to a PhD in molecular biology, and she kept up with scientific advances in the field of fertility, hoping that one day there would be a solution for her. “I’d say infertility affected me every single day in my teenage years and my 20s. I thought about it every single day.” she remembers. Then, in her late 20s, she met her current partner, Nisar. She told him early on about her inability to have children, not wanting to take that choice away from him. “He said, ‘When we get to that stage, we will find a way together.’”

Even today, there are many reasons why a patient may not be offered fertility preservation. Ellie Waters is a 17-year-old social media campaigner who talks about her rare and aggressive type of cancer in blogposts and videos. When she was diagnosed three years ago, there was no time to store any tissue. After the treatment, she experienced hot flushes, which she recognised as symptoms of menopause. She was 15 years old. “So I asked my doctor this question, I asked her, on a scale of 1 to 10, how fertile am I? And she said, zero.” Ellie calmly describes how the treatment ravaged her body: “The concoction of chemotherapy that I had just wasn’t good for my reproductive system. And then you’ve also got the radiotherapy, which killed my left ovary and then scarred my uterus so that meant I couldn’t physically carry a baby.”

Ellie says she has come to terms with this, helped by her online support network. In the videos she posts as Team Ellie, she talks about infertility and survivor’s guilt, but also about her delight at her GCSE results, and her passion for biology, chemistry and maths. She tries to encourage others to value themselves regardless of the state of their ovaries. “Remember that you are amazing,” she says firmly. “We all have our different quirks and there’s always something different about us, so this is just your thing, and you just have to own it.”

Freezing ovarian tissue is not a guaranteed ticket to a family. Currently, only about 30% of transplants result in a pregnancy. And more work needs to be done to reduce the risk that, in adulthood, cancer cells are put back into the patient’s body along with the tissue. Earlier this year, scientists at the University of Edinburgh announced that they had successfully matured human eggs in a lab. Developing eggs or sperm in a lab and using them for IVF could be a way of avoiding that risk. But its advocates say that even with its current limitations, fertility preservation can make a big difference.

“It does give you hope for the future, in terms of, the cancer won’t define you for ever,” says Lauren Shute, a politics graduate at the University of Warwick. She was diagnosed with cancer in 2013, at the age of 17, and chose to store some of her ovarian tissue at the Oxford bank. “It reassures you that treatment is a moment in time, and you’ve just got to get through that bit and everything is going to be OK after.”


James is now six. Lynne is keeping all the details of his treatment in a box for him to read when he is older. In the meantime, she just wants him to lead a normal life (James is his middle name, used to protect his privacy). He is gradually getting stronger, and loves swimming, dancing around the house with his siblings, playing with his friends. He has started primary school. “He just loves being a little boy,” Lynne says. “Every day he amazes me.”

Other survivors have seen science catch up with them. Kate Dobb, whose youth was overshadowed by infertility, had twins with her partner through surrogacy four years ago, with eggs donated by her sister. She is raising awareness around fertility options through two charities, Clic Sargent and Surrogacy UK. Moaza Al Matrooshi, who had a child thanks to her transplant, now wants to try for another. And around the world, researchers are working on ways to make cancer treatment less toxic in the first place.

As for Polly, nature had a surprise in store. At the age of 18, when she assumed she was infertile, she fell pregnant. While we talk on the phone, I hear her baby happily gurgling and babbling in the background. Her voice swells with pride as she lists her daughter’s milestones, and for a moment, she sounds like every other new mother, wholly caught up in the moment. Then our conversation turns to the future. She is expected to enter menopause within a few years. She would like to have more children at some point, but there is a chance that her ovaries will shut down first.

“I do think, maybe that was my last chance of ever doing it naturally. But then I’ve obviously got that wee piece of ovary to fall back on,” she says. “It’s there for the next 55 years if I want it.”

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  • Woman who had child after womb transplant calls for wider availability

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  • Home insemination kits to be trialled on NHS to explore non-IVF methods

  • The NHS helps same-sex couples like us access IVF. But why must we first pay the ‘queer tax’?

  • Secondary infertility forced us to re-evaluate life as a ‘triangle family’

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