Ep02: Ready... Raise... Go!

The origin story behind the season's tools. From a gap in cancer medicine to founding the field of oncofertility, Teresa Woodruff explains why a coloring book sits at the front door of her lab, and how to use it.

Transcript

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Welcome back to Puberty 101 with me, your friendly reproductive scientist, Teresa Woodruff. Think about what it was like to learn to count. You started at the beginning where someone sat with you a parent or grandparent, a teacher, maybe an older sibling, and pointed their finger to a brightly colored page. And they gave you the building blocks one, two, three. And those numbers were exciting. They were yours. Every child I've ever known has gone through a phase where they are drilled by counting. Count the stairs. Count the crackers. Count the cars in the parking lot. There's something deeply satisfying about having a word for something and being able to point at the world and name what you see. That's exactly the philosophy behind what I'm going to share with you today. In episode one, I said the biggest gap in reproductive health education is not the laboratory, it's in the living room. Today, I'm going to give you a tool specifically designed to close that gap at the earliest possible age, in the most accessible way possible. A coloring book, not a textbook or a handbook. Not a diagram with arrows pointed at anatomical structures. Although we are going to learn some anatomy in a future episode, it's a coloring book designed for five or 6 or 7 year olds, or whatever age makes sense in your setting with characters who smile at you from the page. Characters that are warm and friendly and inviting because that's what learning feels like when it's working. The goal of this coloring book is not to overwhelm. It's not to deliver a complete reproductive biology curriculum to a kindergartner. The goal is much simpler and much more important than that. The goal is to open a door to give you a framework for the beginning concepts, so that when harder conversations need to happen, there's already a foundation to build on the same way. Counting makes multiplication possible. The general ideas come first. Now, before I walk you through the coloring book and we're going to do it page by page, I need to tell you where it came from. It was designed because I witnessed a gap in medicine so consequential that I couldn't look away. And the more I tried to close the gap with science, the more clearly I saw that the science alone was not enough.

Let me tell you that story. For most of my career, I've studied the ovary, how it functions across a woman's reproductive life, and critically, what happens when disease or treatment threatens to take that function away? About two decades ago, I started paying very close attention to something that the medical community was not talking about. When a young person is diagnosed with cancer, sometimes a toddler, sometimes a teenager, the entire medical system mobilizes oncologists, surgeons, radiologists, pharmacists, nurses, social workers everyone focused urgently, appropriately, on one singular goal: 2:36

save this child's life. And that's exactly right. That's exactly what should happen. But there was a question. Nobody was asking a question about the future. That question was, what about the fertility of that patient? Over the past 50 years? Biomedical research has made incredible strides in cancer care, such that today, over 80% of pediatric cancer patients survived their disease. Now, for adolescent boys facing cancer treatment, there was at least a pathway. It was awkward. Often the conversation wasn't comfortable, but the option existed. A teenage boy facing chemotherapy could bank sperm. The words existed. The biology was understood. The reproductive medicine community had a framework, however imperfect the conversation was. It could happen for young girls. Nothing. A blank wall. And when a parent, a terrified, exhausted parent sitting in an oncologist clinic trying to absorb a diagnosis they never imagined receiving dared to ask. My daughter wants to be a mother someday. She's always talked about having children. Will this treatment take that from her? The answer she too often received was this. You need to focus on the cancer journey right now. As if wanting a future for her child was distracting from fighting for her child's life. Now, I want to stop right here for a moment, because I don't want you to hear that and walk away angry at the oncologist who said it. Please don't. The doctors giving that answer were good doctors. They were doctors who were fighting for that child's life with everything they had. They cared deeply. They weren't being cruel or dismissive. They just had no tools to offer pediatric oncology and reproductive medicine. The IVF docs had really never sat in the same room together. Nobody owned this problem. The girls fell through the space between two worlds. So I decided to build the room. What my team did with extraordinary collaborators across dozens of institutions and disciplines, was to create a new field of medicine. We called it oncofertility, for the word itself tells you what it is. Onco from oncology the study and treatment of cancer. Fertility from reproductive medicine. Two worlds that needed to find each other. Finally sitting down at the same table. Oncofertility. We developed laboratory technologies to preserve ovarian tissue from young girls before cancer treatment began. To remove a small piece of the ovary, freeze it, protect it, with the goal of restoring that tissue later, after treatment, when the patient was healthy and ready to think about her future, we asked questions that no one had systematically asked before. Can we protect eggs from the damage that chemotherapy causes? Can we mature an immature egg outside the body? Can we give a young woman back something that cancer and its treatment threatened to take from her permanently? Her reproductive cycles, her fertility? Some of those questions we've answered. The science has moved in ways I could not have fully predicted when we started. Some questions were still working on. The research continues. But here's what I need you to understand for today. Here's the thing that connects oncofertility to this podcast, to this episode, to the coloring book I'm about to walk you through as we develop these reproductive technologies for oncofertility patients. As we built this new field, as we train clinicians and wrote protocols and published research, we ran directly into a wall that had absolutely nothing to do with the science. It was a language problem. The same problem that we're talking about in this entire series. When we tried to bring oncologists and fertility specialists together, when we tried to actually implement fertility preservation for young cancer patients and clinical settings, we discovered something that stopped us in our tracks. Nobody knew how to have the conversation. Not the cancer docs, not the fertility doctors, not the parents, and certainly, heartbreakingly, not the children. Does that sound familiar? Think about what that conversation requires. An oncologist who has spent their career focused on tumors and treatment protocols and survival statistics suddenly needs to pivot in the middle of a devastating diagnosis and speak fluently about reproductive biology, about eggs and ovaries, and what fertility means across a lifetime. That's not what they were trained for. That's not where their vocabulary lives. And the fertility specialists on the other side of the room have not worked in a pediatric oncology context. They have no framework for the speed of these decisions, for the terror in the room, for the fact that there may be only days before treatment has to begin. And then there's the parent who is sitting in the room trying to hold themselves together, who is still in the first waves of shock from a word cancer that no parent is ever prepared to hear applied to their child. That parent is being asked to make decisions about fertility preservation, about ovarian tissue, about the future, while simultaneously trying to absorb the fact that their child's life is at risk. Right now, today, this week and then. And this is the part that stays with me, there's the child. How do you explain to a seven year old girl that we want to protect something inside her body, something she may not even know she has, something she's never been taught to name, so that one day, if she wants to, she might be able to have children of her own. How do you have that conversation with a child who has no vocabulary for it? It was never heard the word ovary in a context that makes it real and understandable. And hers, who's never had a trusted adult sit with her and simply and warmly say, this is part of your body and it matters. And here's what it does. Well, the origin of most of the tools in this series is from the oncofertility world. They are for the urgent, unmet need to develop tools for kids and families and even doctors in a crisis. While that's its origin story, its usefulness to you is at home, at your kitchen table on an ordinary Tuesday afternoon when your kid is simply curious, when the stakes are low and the tone is warm and the adult in the room has time to answer questions. And for that to happen, for those ordinary Tuesday afternoon conversations to happen in living rooms all over this country, you need the right words. You don't need things that sound clinical or frightening or something like homework and an exam you need to study for. You need something that a kid feels like an invitation, something that says, come in, this is interesting. There's nothing here to be afraid of. I told you that we adults have often conflated the biology of reproduction with adult sexuality, and we buried the science under layers of awkwardness and shame before children ever had a chance to simply, neutrally, curiously learn the vocabulary. And here is what I've come to believe. The antidote to that is not more clinical language, or better design textbooks, or a more comprehensive health class. The antidote is earlier language friendlier language language at the right developmental level, delivered by the most trusted person in the child's world, the adult who tucks them in at night, who makes their lunch, who they run to, and something goes wrong. The antidote is you sitting with your child, with something approachable in your hands, on an ordinary afternoon when nothing is wrong. So from the in college clinic all the way to you, we made a coloring book, the coloring book, and everything that goes with it lives on our Repro 101 app, a resource that we built specifically to put these tools directly in your hands. Parents. Grandparents. Educators. School nurses. Pediatrician. Anyone who loves the child and wants to give them the gift of knowing their own body. Think of this podcast and the associated toolkit as the front door of the Woodruff lab. And I mean that genuinely, not as a metaphor I'm using to make it sound exciting, but as an actual description of the spirit in which it was built. When you open that app, you are stepping into a scientific space. You are being welcomed as a learner. You're being told your curiosity belongs here. Your questions belong here. You don't need a badge. You don't need a degree. You don't need to have paid attention in your ninth grade biology class. You just push open the door. And that framing is deeply intentional, because one of the things I've spent my career pushing back against is the idea that science is a place for special people, a place for certain kinds of minds, certain kinds of credentials, certain kinds of backgrounds. That's simply not true. Science is a place for curious people. And every child, every single child is a curious person. We just have to make sure we don't train the curiosity out of them before it has a chance to flourish. The coloring book is right there when you come through the door waiting for you. The most important thing I want you to hear before we go page by page is this. You do not need to do this all at once. Please don't feel that you're supposed to sit down with your five year old and get through the entire book in one sitting. That's not what it's for. That's not how children learn, and that's not how these conversations work best. Do one page. Have one small conversation. Let your child color while you talk, because that's actually the ideal situation. A child who is engaged with something in their hands is often a child who's listening more openly, without the pressure of direct eye contact, in the sense that something important is being discussed. One page, one character, one word, one door opened just a little wider. One. Two. Three. Ready? Raise. Go.