July 2025

OB-GYN

CASE STUDY: REPRODUCTIVE PRESERVATION STRATEGIES FOR A YOUNG PATIENT WITH RECTAL CANCER

Featuring: Magdy P. Milad, MD, MS, Emily S. Jungheim, MD

At the start of the COVID-19 pandemic, Iona Woolmington, a 35-year-old woman, was diagnosed with stage 3 rectal cancer following gastrointestinal symptoms. 

The patient's prognosis required a multidisciplinary approach. “Iona’s tumor was located deep within her pelvis, which is a complicated area,” shares Mary Mulcahy, MD, a medical oncologist at Robert H. Lurie Comprehensive Cancer Center of Northwestern University at Northwestern Memorial Hospital. Dr. Mulcahy emphasized that both chemotherapy and radiation are crucial in reducing tumor size before surgical intervention but can affect ovarian function and fertility.

Figuring in the Fertility Considerations

In light of these considerations, Dr. Mulcahy referred the patient to Northwestern Medicine Center for Fertility and Reproductive Medicine, where clinicians created a fertility-sparing strategy. “When we see a patient early on, the goal is to do as much as we can to potentially preserve the possibility of having a child down the road,” says Emily S. Jungheim, MD, chief of Reproductive Endocrinology and Infertility. To preserve the patient’s fertility, the team recommended two primary procedures: 
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  • Oocyte cryopreservation 
  • Ovarian transposition to reposition the ovaries

Oocyte cryopreservation allowed the patient to bank high-quality oocytes before starting cancer treatment. Ovarian transposition repositioned the ovaries away from the radiation field. According to Magdy P. Milad, MD, MS, chief of Minimally Invasive Gynecologic Surgery, this technique is key to preventing premature menopause and mitigating long-term health risks, including cardiovascular disease and osteoporosis.

Onward to Cancer Treatment

After completing these fertility preservation procedures, the patient began her chemotherapy and radiation regimen. After six months of treatment, she underwent a colon resection in February 2021, successfully removing the cancerous rectal tissue and restoring gastrointestinal continuity.

The patient was provided with a temporary ileostomy during her post-op recovery to manage waste diversion effectively. Today, the patient is cancer-free, and her ovarian function remains intact, emphasizing the effectiveness of her care team in addressing both oncological and reproductive health needs.

This case underscores the critical importance of integrating fertility preservation into the treatment plans of young patients facing cancer, especially when their treatment protocols may jeopardize reproductive health.
Magdy P. Milad, MD, MS, Chief of Minimally Invasive Gynecologic Surgery in the Department of Obstetrics and Gynecology, Albert B. Gerbie, MD, Professor of Obstetrics and Gynecology, and Professor, Minimally Invasive Gynecologic Surgery
Emily S. Jungheim, MD, Chief of Reproductive Endocrinology and Infertility in the Department of Obstetrics and Gynecology, Edmond Confino, MD, Professor of Obstetrics and Gynecology, and Professor, Reproductive Endo and Infertility.

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