Ovarian biology and reproductive science expert Teresa Woodruff was recently awarded the National Medal of Science. She talks about how she first became fascinated with science in elementary school, the excitement of ‘Aha!’ moments, and how reproductive science affects us all.
A cancer diagnosis brings an overwhelming number of medical decisions, and fertility preservation may seem like a distant concern for young patients facing an existential crisis. Teresa Woodruff recognized that better collaboration between cancer and fertility specialists could improve reproductive options for patients receiving life-saving treatments that affect fertility. She founded the field of oncofertility to build that collaboration and support comprehensive care for patients. Today, the field has grown exponentially and fertility preservation is integrated into standard cancer care. Woodruff is also dedicated to improving how medical research is conducted. She championed the 2016 National Institutes of Health policy mandating the inclusion of women in clinical research.
Teresa Woodruff
Woodruff is the MSU Research Foundation Professor of obstetrics, gynecology, reproductive biology, and biomedical engineering at Michigan State University. In 2011, Woodruff received the Presidential Award for Excellence in Science, Mathematics, and Engineering Mentoring. She was elected to the National Academy of Medicine (NAM) in 2018. She is also an elected member of the American Academy of Arts and Sciences, the National Academy of Inventors, and the American Institute for Medical and Biological Engineering and is a Guggenheim Fellow.
Woodruff recently spoke with the NAM’s Jamie Durana about how the oncofertility field has changed cancer care, why including women in clinical research benefits everyone, and why she’s passionate about reproductive health education for all.
The following interview has been edited for length and clarity.
What originally sparked your interest in science? Were there early influences that led you to pursue medicine?
Woodruff: My mother was a first-grade teacher and her mother, my grandmother, was a teacher of all grades in the Oklahoma panhandle. I have this matrilineal lineage of educational leaders, and, when I went to college, I thought I would go into elementary education. But, during my time in college, I became really fascinated with science and with research.
The true first spark for me was back in elementary school when my mom ran science programs for kids around our town. I got to attend those programs on her skirt tails, and I found I really loved learning about earthworms—that was one of the big starting points for my interest. Then, of course, the science fair! In fact, in the science fair, I did work with chicken eggs and that has lined up with my interest in the mammalian egg. Those early science fair days were really important to me.
Can you share the inspiration behind establishing the field of oncofertility?
Woodruff: In the late 1990s, I was the basic science director at the Robert H. Lurie Comprehensive Cancer Center at Northwestern University and an adolescent boy was brought down from our pediatric hospital to bank his sperm. That was unheard of then. I’m a reproductive scientist, not a cancer biologist, and was basic science director in part because they thought I was a good leader, and it was fascinating to be in that role. When I heard about that case, I was intrigued. I asked what kind of fertility preservation we do for young women patients and the physician I spoke with said, “Oh, we shouldn’t worry about that—they need to focus on the cancer treatment.” That struck me as a real mismatch. This is before Lance Armstrong had his sperm banked and really brought attention to fertility preservation care for cancer patients.
Around that time, it became very clear that the scientific discoveries I was making in terms of ovarian follicle development could be applied to this field of fertility management for young cancer patients. I originally started something called the Center for Families After Cancer, but that was not a great term for the medical field, so I coined the term oncofertility to describe fertility management in the cancer setting.
Now the field has expanded to ensure that, no matter what type of treatment a patient is undergoing—whether it interrupts fertility, puberty, or hormones—we have options for preserving reproductive potential for those individuals.
What were some of the early challenges and milestones in establishing the field?
Woodruff: One of the biggest early challenges was the disconnect between cancer and fertility specialists. Oncologists often believed that hormones caused cancer and fertility doctors didn’t feel there was enough time available to offer options to young women undergoing treatment. Fertility specialists were used to working with patients over long periods to address infertility, not with urgently ill individuals. These two fields of medicine had different operational ways of thinking and there weren’t real corridors of communication.
Early on, progress was often driven by individual patients, or moms of kids who were patients, who were really saying, “I believe my child will survive this disease, and I want them to have some options.” Those cases were very few and far between and, in fact, when it happened, it would be reported in the New York Times. Another hurdle was that we didn’t know how to intervene in a timely manner for young cancer patients. Discussing fertility with someone who’s young and facing a life-threatening illness is not the same kind of conversation with someone who is an adult experiencing infertility. We had to develop a way to discuss fertility options with someone having a terribly devastating diagnosis—it changed the way in which we had to think about it.
The field’s development was shaped by milestones happening in cancer care and reproductive technology. At the time, survivorship rates for cancer were improving thanks to advances in therapeutics and radiation that had emerged following the “war on cancer” launched in the 1970s during the Nixon administration. There was a convergence of cancer therapeutics and new reproductive technologies being developed. In part, we created this field to start bringing oncology and fertility together in a way that there was this brand-new dialogue called oncofertility.
The time between an initial cancer diagnosis and the time a patient can receive fertility preservation treatment has shortened. Originally, in vitro fertilization was off the table, but now it’s on the table as an option. Planning for a family, long-term, is now part of the equation. Even if a patient’s diagnosis seems daunting, having that conversation at the earliest moment provides what we call a “circumference of care,” or the full circle of consultation available to each patient. That also means, if something happens down the line, patients always have a care team they can come back to.
These are some of the critical medical options that now are provided literally around the globe. We started with a national physicians’ cooperative in the United States, broadened it to North America, and now it is around the entire world.
You’ve just been honored by President Biden with the National Medal of Science for your contributions in oncofertility. What does this recognition mean to you, both personally and in terms of advancing the field?
Woodruff: I never expected anything like this, and you don’t do the work for this kind of recognition. The thing that’s most important is that this honor highlights reproductive health as an essential part of an overall healthy population. Reproductive science is sometimes limited to the sidelines, but, of course, it is critical for all of us. Highlighting reproductive advances that are creating the context for families, I think, is just fantastic. I’m personally honored, and I’m delighted for my lab and for everybody that I’ve collaborated with. This award is for that broad community of people who have worked—who have pulled together—to build oncofertility as a discipline.
The establishment of oncofertility as a field has built bridges in care provision. Can you reflect on how interdisciplinary collaborations contribute to breakthroughs in fertility preservation for cancer patients?
Woodruff: I think the breakthrough has really been in terms of communication. We created the very first oncofertility patient navigator role in 2007. Patient navigators are now very common, but back then there weren’t people who walked between disciplines. Our oncofertility patient navigator—who is centered at Northwestern University—not only navigates patients, she navigates patient calls and provider questions every day, and just last week we had over 100 Oncofertility Consortium patient navigators at the Consortium’s annual meeting. This is critical work that I believe is difference-making.
In many medical fields, clinicians train only within their fields, but we provide cross-disciplinary training on an ongoing basis. It’s a fascinating new model that I think will probably gain steam in other interdisciplinary medical fields.
On the first day at our Oncofertility Consortium meetings, we have what we call Oncofertility 101. This training is for our first-, second-, and third-year fellows who are in pediatrics, gynecology, urology, oncology, psychology: all the different fields of service that intersect when a patient needs fertility management.
It’s an exciting and dynamic field of development. It’s really needed, and it keeps even the most senior physicians in an active, rather than static, mode. This continuous feed-forward and feedback loop is what continues to develop the field. Through the Oncofertility Consortium education, research and patient care information is delivered to every physician involved in patient management.
You’ve been a champion for policy changes to include women in research. How do you see this shift impacting reproductive health research in the long term?
Woodruff: I celebrate January 16 every year—the day in 2016 when NIH mandated the inclusion of sex as a biological variable in fundamental research. This was critical because it means the entire scientific-to-medical pipeline now includes this basic foundation that will improve medicines for everyone.
Historically, we’ve seen adverse responses to medications in women, in particular, because they weren’t included in clinical trials. Medications weren’t tested on sex-specific organs, both reproductive and non-reproductive. This is something that we’ve tried to fix. One thing I’ve told everyone is that including sex as a variable gives you a completely new way of looking at things. I would be very excited to be a young person coming into science and medicine today because this presents a whole new outlook for discovery research.
The inclusion of women in these disciplines is also critical for fostering dynamic approaches to asking questions and uncovering essential truths. A diversity of thought and perspective shapes how we engage with fundamental scientific questions. I’ve been particularly pleased with our high school programs, which President Obama acknowledged in 2011. It’s critical that we continue training the next generation to think broadly about how they approach scientific questions. We simply cannot eliminate half of the biology that could help us develop the best possible medicines for everyone’s health.
Your work includes a wide range of educational initiatives like the Women’s Health Science Program and the Oncofertility National Science Education Network among others. What inspired you to launch these programs and how do you see their role in filling knowledge gaps for patients and clinicians?
Woodruff: It all goes back to my mom and grandmother. I’ve always been an educator, and education remains a critical part of my work. When we started these educational programs, there weren’t many opportunities for kids to come into laboratories. We decided to develop programs that welcome kids and their parents to come in and be part of what we’re doing. I call it going from horizontal learning—that is learning what’s in the book—to vertical learning, where you’re learning how to ask questions. This approach can be truly inspiring to students, and that was the primary impetus for these programs.
I also created a Coursera course called Introduction to Reproduction and around 28,000 people have now taken it. Many people don’t understand the fundamentals of reproductive organs and how they work, so this course helps bridge that knowledge gap.
Another important area is reproductive health terminology. There are many terms that have been misused or sometimes used in derogatory ways. Repropedia is a resource to combat that. It’s a Wikipedia for reproductive health terms where you can find accurate definitions rather than potentially ending up in unsavory parts of the web.
In addition to these online toolkits focused on reproductive health broadly, we’ve created patient portals that provide educational information in the oncofertility setting. Often, patients might understand information during their provider visit, but when they go home, the overwhelming nature of their situation makes it difficult to put everything into context. These resources provide durable, accessible material for patients.
We want to make sure our work isn’t just about moving from grant to paper and back again. It’s important to fill the needs of the patients and community our work serves. That’s why we’re focused on education.
Looking forward, what most excites you about the future of oncofertility, both in terms of scientific advancements and its integration into standard cancer care?
Woodruff: In most places, it is now standard care for young cancer patients—certainly in most pediatric hospitals across the United States and most around the globe. But there are still advances that need to be made.
We need to understand more about how the ovarian follicle works: how individual follicles are selected at particular times during the life cycle of an individual. We also need to understand the timing of puberty and how those follicles then change in their function pre- and post-puberty for our young cancer survivors. We need to create ways to provide not just fertility options but durable hormonal changes—beyond just an estrogen patch—to include all the hormones that either the ovary or testis makes that are necessary to overall health. These are three critical things that many people are working on now.
In terms of medical care, it’s essential to have continuing dialogue with patients throughout their lives and to make sure there is a smooth handoff from pediatric to adult care. Once you’ve survived cancer, you go on and live your life, and we want to make sure that, even as you’re moving into adult care, reproductive opportunities are still available to you.
What message would you like to impart to the next generation of researchers in reproductive science?
Woodruff: That there are discoveries waiting to be made that we can’t imagine today. One of the discoveries I made with my collaborator Tom O’Halloran and our labs was that, at the time of fertilization, there is this release of zinc called the “zinc spark,” and it’s required in order to get an egg to maturation. We never even knew to look for zinc release at fertilization. It is the truest of all discoveries. It’s that “Aha!” moment—that zinc spark—that is why we have to keep going, because we really know so little about the processes that give rise to healthy human development. The next generation of researchers should know that there’s excitement and opportunity within the field, and there’s a real necessity to learn and understand all we can about reproductive health because healthy beginnings create healthy populations.
Views expressed are those of the interviewee and do not necessarily reflect the views of the National Academy of Medicine.
