Abstract:
The invention relates to ovary apparatus for regulating the temperature of the ovary; and shielding it from radiation. The main function of the device is to preserve fertility of women treated with chemotherapy by lowering the ovary temperature while the toxic medications circulate in the patients&#39; blood. The current invention utilizes shielding of the ovary to protect it from radiation, and temperature decrease to further limit the toxic effect of radiation.

Description:
FIELD OF THE INVENTION 
     The present invention relates to a medical device that modulates the ovary temperature, in order to modulate its function, and preserve fertility, especially of women who suffer from cancer and receive treatments that jeopardize fertility such as chemotherapy. 
     BACKGROUND OF THE INVENTION 
     Fertility is the ability of a person to make children through mating with a person from the other sex. The ovaries in women and the testicles in men are vital organs to fertility in women and men, respectively. Ovaries and testicles (gonads) contain ‘gametes’ which are haploid cells (gametes contain half of the set of chromosomes found in the other human cells). The ovarian gametes are called ‘ova’, and the testicular gametes are called ‘sperm’. Healthy men are usually able to produce sperm from adolescence till late adulthood; conversely women are born with about 100,000 ova per ovary and with age this number decreases steadily; by puberty only about 30,000 ova per ovary survive, and from puberty till menopause only 300-400 ova ripens. Beside production of gametes, the gonads have vital functions related to hormonal production such as estrogen, progesterone and testosterone secretion which affects many organs in the body and changes in these hormones can result in a variety of problems such as libido disturbances, mood disorders, cardiovascular disease and bone density disturbances (osteoporosis). Moreover, suppression of the hormonal production in the gonads is utilized in treatment of cancer diseases: Castration (either surgical or chemical) is widely used to treat metastatic and locally advanced prostate cancer; and ovarian suppression is used to treat breast cancer patients suffering from tumors expressing estrogen or progesterone receptors. Gonadal function preservation and/or function modulation are needed in the following settings:
     Fertility preservation in patients treated due to cancer disease.
       a. Women. Cancer is the second cause of death in western countries. One out of ten women, on average, suffers from breast cancer. In 2008, approximately 182,000 women in the United States were expected to receive a diagnosis of invasive breast cancer, of these patients, an estimated 16,000 were younger than 45 years of age (1). ‘Chemotherapeutic agents routinely used for the treatment of breast cancer include cyclophosphamide, fluorouracil, doxorubicin, pa-clitaxel, and docetaxel. Alkylating agents, including cyclophosphamide, are quite toxic to the ovaries, particularly to the primordial follicles, which represent the ovarian reserve. Although the effect of chemotherapeutic regimes on fertility is predicated or the baseline ovarian reserve, treatment effects become particularly pronounced by the time patients reach 40 years of age.’ (1). As detailed in a recent review in the New England Journal of Medicine (1) ‘Several options are available to women with cancer who wish to preserve their germline. Patients may elect to delay cancer treatment in order to undergo one cycle of hormone stimulation, followed by cryopreservation of either a mature oocyte or an embryo. Both techniques require a delay in cancer treatment for up to 1 month; this may not be an option for some patients. Cryopreservation of mature oocytes is considered experimental, although more than 100 live births have been reported with the use of this technique,’ (1) ‘Fertility-preservation techniques that do not require hormonal exposure are available. Ovarian tissue can be obtained at the time of diagnosis without additional hormonal stimulation, thus only minimally interfering with the patient&#39;s treatment plan. Depending on the day of the menstrual cycle, oocytes may be aspirated from the ovary, matured in vitro, and then cryopreserved for later use. In addition, individual follicles or strips of ovarian cortical tissue can be cryopreserved directly for future use in either in vitro follicle maturation or tissue transplantation. Thus far, five live births have been reported in women with cancer who underwent autologous transplantation of cryopreserved ovarian tissue.’ (1)   b. Men. Men undergoing chemotherapeutic treatments and wish to preserve their fertility undergo usually sperm banking. When the patient and his spouse wish, the spouse undergoes insemination or in vitro fertilization. This method, although effective, do not preserves the natural fertility of the man, and these patients may suffer from chemotherapy induced oligospermia, which complicates the conception process. Moreover, if the banked sperm get lost or defective the patient&#39;s options for parenthood decrease.   e. Children. In the United States, 10,700 new cases of cancers were diagnosed in children in 2008 (1, 2). Of these patients, nearly 80% were expected to survive (2). Treatment regimens for childhood cancers are extremely toxic and pose a threat to the fertility of young patients (1). The current options for fertility preservation are limited in their effectiveness in both girls and boys (especially those before adolescence).   
       2. Women with hereditary genetic mutations in genes such as BRCA-1 and BRCA-2 are at increased risk for ovarian cancer. The current practice is to perform ovarian resection as early as possible to these women, preferably before the age of 25-30 years, before the development of cancer. Clearly, resection of the ovaries at young age results in compromise of the fertility in these women, as well as induces early menopause. Currently, there is no method to prevent or delay cancer development in ovaries of women with genetic mutations posing them at increased risk of ovarian malignancies.   3. Broadening the ‘fertility window’. As stated above, fertility of healthy women decreases with age. Above age 30-35 years it becomes more difficult for women to get pregnant. In the last century more and more women arrive to this age without children due to either career related issues or due to lack of appropriate spouse. These women seek methods to broaden the ‘time window’ of pregnancy beyond the age of 40 or 50 years. Currently, there is no solution for healthy women to broaden the fertility window.   4. Delaying menopause. By the age of 50 years most women arrive to menopause. Menopause results from lack of ovarian functionality, not solely lack of ovulation, but also lack of production of sex hormones (e.g. estrogen and progesterone). Beside its effect on fertility, the hormonal changes at menopause results in changes in almost every organ. Lack of estrogen results in faster aging, more heart diseases (atherosclerosis), and bone density changes (osteoporosis). Women beyond the age of menopause can use hormone replacement therapy to compensate for the hormonal changes that ovarian failure causes by menopause, and lower the development of osteoporosis, coronary heart disease, and changes to the skin texture.   5. Birth control. Family planning and pregnancy timing are widely used in the last decades by women. There are a variety of birth control methods available for women. This includes birth control pills, intrauterine device and a variety of mechanical barriers.   6. Polycystic Ovary Syndrome Polycystic ovary syndrome is one of the most common female endocrine disorders, affecting approximately 5%-10% of women of reproductive age (12-45 years old) and is thought to be one of the leading causes of female subfertility (6). Medical treatments of women with infertility due to polycystic ovary syndrome rely mainly on medications such as clomiphene citrate. Surgical treatment of infertility due to polycystic ovary syndrome include either ‘wedge resection’ of one ovary, or ‘ovarian drilling’ which can be done laparoscopically by making small holes in the ovarian coating or capsule with a laser or cautery needle. Ovarian wedge resection and ovarian drilling results in induction of ovulation in women suffering from polycystic ovary syndrome for a limited number of months after the procedure, providing the opportunity to these patients to get pregnant.   7. Treatment of breast cancer patients with ovarian suppression. Ovarian suppression, with the use of gonadotropin-releasing hormone analogues, plus tamoxifen is a standard adjuvant treatment in premenopausal women with endocrine-responsive breast cancer (8). Resection of the ovaries, is another alternative to ovarian suppression with long acting gonadotropin-releasing hormone analogues, but is usually reserved for women with hereditary breast and ovary genes mutations.   

     Use of Hypothermia to Protect Tissues and Organs from Chemotherapy. 
     Changes in temperature are used in limited situations in cancer patients to decrease exposure to chemotherapeutic drugs, and thus preserve the organ function:
     1. Prevention of Chemotherapy-Induced Hair Loss with Scalp Hypothermia: Treatment of patients who suffer from cancer includes the administration of chemotherapeutic drugs such as doxorubicin and cyclophosaphamide which induce hair loss, alopecia, in many cases. Prevention of doxorubicin-induced hair loss with scalp hypothermia was reported in many controlled trails as early as the report in the New England Journal of Medicine in 1979 (4), Satterwhite et al. showed that scalp hypothermia resulted in preservation of hair in 75% of patients treated with doxorubicin as compared with 8% in the control group (5). The mechanism by which cooling results in preservation of hair is not well characterized, but is thought to be a combination of decreased exposure to chemotherapy during the cooling period, and decrease in the hair follicle metabolic rate, which culminates in resistance to chemotherapy. Because chemotherapy disturbs the normal metabolizing cell, cooling the cell, decreases its metabolism and puts a significant part of its functions ‘on-hold’ rending chemotherapy less active.   2. Hypothermia gloves are frozen gloves that the patient wears in order to protect fingers and nails from the side effects of chemotherapy (3). Onycholysis and skin toxicity occur in approximately 30% of patients treated with docetaxel. A multicenter study by Florian Scotté et al. (7) showed that frozen glove significantly reduces the nail and skin toxicity associated with docetaxel and provides a new tool in supportive care management to improve patient&#39;s quality of life. In this study, patients receiving docetaxel 75 mg/m 2  alone or in combination with other chemotherapy were eligible for this case-control study. Each patient wore a frozen glove for a total of 90 minutes on the right hand. Onycholysis and skin toxicity were significantly lower in the frozen glove-protected hand compared with the control hand (P=0.0001). Onycholysis was grade (G) 0 in 89% v 49% and G1 to 2 in 11% v 51% for the frozen glove-protected hand and the control hand, respectively. Skin toxicity was G0 in 73% v 41% and G1 to 2 in 27% v 59% for the frozen glove-protected and the control hand, respectively (7).   

     SUMMARY OF INVENTION 
     The present invention relates to ovary apparatus for regulating the temperature of the ovary. The use of cytotoxic agents, for example, chemotherapy for cancer patients leads to injury to ovarian cells and reduce fertility. The current invention utilizes temperature changes in order to modulate function, or to preserve function of the ovary. The normal body temperature is 37° C., by decreasing the temperature of the ovary (while it inside the body connected to its normal blood and nerve supply) the current invention results in decrease in the ovary metabolic rate, change the blood flow to the ovary and decrease the ovary sensitivity to toxic materials such as chemotherapy. The current invention is designed to selectively change the temperature of the ovary or past of it without changing of the temperature of the whole body. The preferred embodiment is to decrease the temperature of the ovary to less than 37° C. for varying time periods in order to modulate its function or preserve its function. The preferred embodiment is related to decreasing the ovary temperature in order to preserve its function during cancer treatment or to extend its functionality period in healthy people. Other embodiments are selective increase of the temperature of part of the ovary in order to induce ‘wedge resection’ of the ovary and hence induce ovulation in women suffering from polycycstic ovary syndrome. Other uses for ovarian temperature modulation device of the current invention, include: modulation of hormone secretion from the ovaries through ovarian cooling; decrease in the metabolic rate of the ovaries thought decreasing ovarian temperature below 37° C. in order to prevent development of breast and ovary malignancies in young women with genetic mutations posing them to ovarian and breast carcinomas; birth control; delaying menopause; protecting the ovary from radiation induced damage by modulating the temperature of the ovary, decreasing its metabolic rate, and decreasing free radical production in the ovaries by radiation through ovarian cooling. Another embodiment of the invention is an ovary shielding device ( FIG. 2 ), the external walls of the device built from radiation shielding materials such as lead, with a possibility to control its internal cavity temperature, which contains the ovary, in order to further decrease the harm from radiation to the ovary. 
     The fertility preservation device is an implantable device, in one embodiment it functions as a small cooling machine, in which the cooling part encases and covers the ovary like a glove cover the hand; or, in other embodiment, an intra arterial cooling stent inserted into the ovarian arteries cool the blood supply to the ovary and thus results in reducing the temperature of the ovary. The device may be inserted through a bed-side gynecologic procedure in which the device introduced through the vagina to the uterus to the fallopian tubes and from there to the ovary. Alternatively the device may be implanted through laparoscopic or open surgical procedures. Alternatively, in the case of an intravascular cooling stent the device may be inserted through angiographic procedures. The energy supply can be from a battery that can be recharged from outside the body, or through an external electric source, or from transforming the body temperature or the movement of its organ to an electric power that supplies the energy needed for this device. The temperature level and length of the temperature changes will be modulated according to the goal of the treatment (see ‘Background of the Invention’). The range of temperature is between −20° C. to 100° C., and the cooling period range is from minutes to years. For preserving fertility in women treated with medications that affect fertility (e.g. chemotherapy) the length of ovarian temperature modulation will be set till the concentration of the medication in the blood decrease below its expected gonado-toxic level (this may also be calculated according to the expected half-life of the medication). The return of the temperature of the ovaries to the normal body temperature may be abrupt or gradual, according to the clinical needs. By decreasing ovarian temperature this invention will decrease the metabolic function of the gonads cells and thus protect them from the cytotoxic effect of drugs such as chemotherapy and front exposure to radiation therapy harms. The current invention, temperature modulation device that covers the ovaries, can be produced from or covered by radiation protecting materials such as lead, in order to further protect the gonads from radiation. 
     Other uses of the invention related to gonadal and ovarian function modulation, include decreasing the temperature of one ovary or both ovaries in order to extend ‘fertility window’, delay menopause, delay menarche, induce menarche, or induce menopause. The current invention can be used to suppress gonadal hormonal function through modulation of ovarian temperature; preferably cooling the gonads will result in hormonal suppression which can be used for treating hormone sensitive malignancies such as hormone receptor positive breast cancer. Extending the fertility window may be achieved by cooling one ovary for long period, and following the menopausal status of the woman; when the on-cooled ovary stop functioning and the woman approaches menopause, then the temperature of the cooled ovary is returned to normal body temperature or near body temperature, in order to allow fertility beyond menopause. As there is relation between hormonal function and aging, this device can be used for modulating the temperature of ovaries in order to delay aging. For example, temporary cooling of one ovary by using the current invention, can result in preserving ovarian function ‘beyond menopause’, which results in longer pre-menopausal life, and less aging. 
     The current invention can be used as a birth control method through modulation of ovarian temperature. 
    
    
     
       DESCRIPTION OF DRAWINGS 
         FIG. 1  shows a schematic view of the women uterus  1 , fallopian tubes  2  and ovaries ( 3  &amp;  4 ) and the ovarian apparatus for regulating the temperature of the ovary and shielding it from radiation  5  covering the right ovary  4 . 
         FIG. 2  shows one embodiment of the apparatus for regulating the temperature of the ovary utilizing the thermoelectric effect. The ovary  4  is encased by the temperature regulating apparatus  5 . Enlarged inset of one embodiment of the ovarian temperature regulating apparatus is composed of an internal layer and an external layer. The internal layer  6  is lining the apparatus and contacting the ovary  4 . The external layer is made from an insulator material and a radiation shielding material such as lead  7 . The external layer is composed of a conductor  8 , an n-type thermo-element  9 , a p-type thermo-element  10 , and a direct current source  11 . 
         FIG. 3  shows an embodiment of the apparatus for regulating the temperature of the ovary  5 , composed of cells, in which the temperature of each cell can be controlled individually. Each cell is designated fey horizontal number  12 , and vertical letter  13 , and utilizing a remote control  14 , the temperature of each cell is set from outside the body of the patient while the device is already implanted and encases the ovary. 
         FIGS. 4 a -4 b    show an embodiment of the apparatus for regulating the temperature of the ovary in the shape of vascular stent.  FIG. 4 a    the cooling stent is shown in its open format  16 , the cooling surface of the apparatus is forming the internal wall of the stent  15 , while the external wall of the stent is made from insulating material and faces the blood vessel endothelium,  17 .  FIG. 4 b    is an enlarged schematic description of the stent wall composed of external layer made from insulator material  17 , conductor  8 , n-type thermo-element  9 , p-type thermo-element  10 , and direct current source (not shown). 
     
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
     In accordance with the invention, the toxic effects of chemotherapy on ovarian function in premenopausal women treated due to cancer could be reduced by decreasing the temperature of the ovary during treatment. The ovary is a small oval organ with dimensions of about 1.5 cm×3 cm; the current invention is an implantable device, which modulate the temperature of the ovary. By reducing the temperature of the ovary, the metabolic rate of ovarian cells decrease, energy consumption of the ovarian cells decrease, and blood flow to the ovary change. This change due to lowering of the ovary temperature decreases the vulnerability of ovarian cells to chemotherapy, similar to the decreased hair loss from scalp cooling, and the lower toxicity to the nails when using freezing gloves during chemotherapy treatments. 
     In another aspect of the invention, sufficient decrease in the temperature of the ovaries by the current invention will result in decreased hormonal secretion from the ovaries, which can be utilized to treat breast cancer malignancies in premenopausal women with endocrine-responsive breast cancer. 
     In yet another aspect of the invention, and in order to further protect fertility of women suffering from cancer treated with radiation, an implantable ovarian cooling device of the current invention, shaped in shell-like form ( FIG. 1 ), or covers the ovary like a glove cover the hand (in one embodiment), with its external wall built from materials that function as a shield for the ovary from radiation ( FIG. 2 ), such as lead or any other radiation shielding material, in order to physically decease the gonads exposure to radiation, and assist in visualizing the location of the gonads during radiation therapy simulation, and before each radiation session treatment in order to treat the patient with image guided radiation therapy (IGRT) technique, and lower the total radiation dose that the ovary receive during radiation of abdominal or pelvic tumors. Lowering the temperature of the ovary during radiation therapy reduces its metabolic rate, decrease free radicals production, and makes the ovary less vulnerable to radiation. 
     In yet another aspect of the invention, the medical device of the current invention lowers the temperature of the ovary, which results in lowering its metabolic rate. Prolonged moderate-cooling of the ovary can prevent aging of ovarian cells, and delay menopause by a time equivalent to the cooling period of one of the ovaries. For example, if cooling of the right ovary was initiated when the woman was 35 years old, for 15 years, then after cooling stops at age 50, the right ovary will be more active than the left un-cooled ovary, which results in delaying the menopause of the treated woman. 
     In one embodiment, the ovarian-temperature-modulating-device has a shell-like shape ( FIG. 1 ), or glove-like shape that covers the ovary and contains it, and modulates its temperature. In this embodiment, the temperature of the ovarian cortex can be highly controlled. In this embodiment, the ovarian cortex comes into close contact with the interior side of the medical device described in the current invention. The temperature of the ovarian cortex in this embodiment can be homogenously or differentially modulated. In the embodiment that deferentially modulates the ovarian surface cortex ( FIG. 3 ), temperature differences between the different areas of ovarian cortex can be obtained by matrix-like-device which is divided into cells in which the temperature of each cell can be controlled. The matrix covers the ovary, and comes into close contact with the ovarian cortex, and hence the temperature of each part of the ovarian cortex can then be controlled by changing the temperature of the different matrix cells. Each square millimeter of ovarian cortex, surface can be cooled or heated to different temperature, allowing temperature differences between the different areas of ovarian cortex. Differential temperatures of the ovarian cortex, can be used to treat women with poly cystic ovary syndrome, in order to induce wedge-resection-like local injury to the ovary, or ovarian-drilling like injury to the ovarian cortex. In this example, one or two millimeters of ovarian cortex are heated to 75-100° C. for 15 minutes, while the ovarian cortex that borders this area is maintained at 20-37° C. This differential temperature modulation will result in controlled injury to the ovarian surface, and induce ovulation in patients with polycystic ovary disease. Given the possibility that this device can be remotely controlled ( FIG. 3 ), each time the women desire to ovulate, an increase in the temperature of small part of the ovary is performed in order to induce ‘wedge like’ temperature induced destruction. If the women desire to repeat the procedure in the future, then another part of the ovary will be chose in order to induce wedge resection. 
     In another embodiment, ovarian-temperature-modulating-device of the current invention has a stem-like shape ( FIGS. 4 a -4 b   ), inserted through angiographic procedure into the blood vessel that supply the ovary, and cool the blood that arrives to the ovary, resulting in reduction of the temperature, of the whole ovary. 
     In another embodiment, the current ovarian-temperature-modulating-device can be utilized for prevention of cancer development in ovaries of women with genetic mutations posing them at increased risk of ovarian malignancies. Women with hereditary genetic mutations like BRCA-1 and BRCA-2 gene mutations are at increased risk for ovarian cancer. Through the current invention a decrease of the ovarian temperature in these women will decrease the metabolic rate in the ovaries, and decrease the possibility for development of cancer in the cooled ovaries. Moreover, reducing the temperature of the ovaries in these gene mutation carriers will result in decrease in estrogen and progesterone secretion torn the ovaries, which will result in beneficial consequences in terms of lowering the probability to developing breast cancer in these patients. 
     In one embodiment of the invention, Peltier effect is used to create a heat flux between junctions of two different materials. As detailed in  FIG. 2 , the ovary  4 , is covered by ovarian fertility device of the current invention  5 . The wall of this device is composed from several layers  6 - 9 , an internal layer lining the apparatus and contacting the ovary  6 , external layer made from insulator material and radiation shielding material such as lead  7 , conductor  8 , n-type thermo-element  9 , p-type thermo-element  10 , and direct current source  11 . The device can be inserted ( FIG. 1 ) by invasive procedure, or by non-invasive procedure, through the uterus  1 , fallopian tubes  2 , and then stretched over the ovary  4 . The device can be applied to one ovary  4 , as in  FIG. 1 , leaving the other ovary  3  in its natural ambient, or two devices can be applied, each to one ovary (not shown). While thermoelectric effect is described here as an example to reduce or increase temperature, other methods such as utilizing coolant liquids, or methods utilized to cool electronic chips, laser lamps, or simple refrigerators could be utilized as well to achieve the goal of the current invention of modulating the ovary temperature. 
     While the apparatus described herein utilizes temperature changes in order to modulate ovarian functions, it&#39;s clear that the same methodology could be used to modulate the function of other internal organs through increase or decrease of temperature such as modulation of the temperature of the pancreas to treat diabetes, or to modulate the temperature of the pancreas for modulating its hormonal function. Moreover, the same device can be used to modulate the temperature of un-resectable tumors, such as pancreatic tumors, in order to disturb tumor cells metabolic rate by either reducing or increasing the tumor temperature from 37° C. and thus extend life and quality of life of patients. 
     While the invention was described with respect to limited number of embodiments, it will be appreciated that many variations, modifications and other applications of the invention may be made. 
     REFERENCES 
     1. Jeruss J S, Woodruff T K. Preservation of fertility in patients with cancer. N Engl J Med. 360: 902-911 (2009). 
     2. Cancer facts &amp; figures 2008. Atlanta: American Cancer Society, 2008. 
     3. http://www.fordmedical.co.uk/id14.html 
     4. Prevention of Doxorubicin-Induced Hair Loss with Scalp Hypothermia, Judith C. Dean, R.N., M. S., Sydney E, Salmon, M.D., and Katherine S, Griffith, R.N. N Engl, J Med 1979; 301:1.427-1429 
     5. The use of scalp hypothermia in the prevention of doxorubicin-induced hair loss, Satterwhite B, Zimm S, Cancer, 1984; 54(1);34-7, 
     6. Polycystic ovary syndrome. Wikipedia, the free encyclopedia http:/en.wikipedia.org./wiki/Polycystic_ovary_syndrome (approached Jul. 30, 2011). 
     7. Multicenter Study of a Frozen Glove to Prevent Docetaxel-Induced Onycholysis and Cutaneous Toxicity of the Hand. Florian Scotté et al.  Journal of Clinical Oncology , Vol 23, No 19 (July 1), 2005: pp. 4424-4429. 
     8. Endocrine Therapy plus Zoledronic Acid in Premenopausal Breast Cancer. Michael Gnant et. al. N Engl J Med 2009; 360:679-691.