Background The post-treatment quality of life (QOL) impacts of receiving pre-cancer-treatment infertility counseling and of pursuing fertility preservation have not been described in large-scale studies of reproductive age women with cancer. Methods 1041 women diagnosed between the ages of 18 and 40 responded to a retrospective survey and reported whether they received infertility counseling before cancer treatment and whether they took action to preserve fertility. Five cancer types were included: leukemia, Hodgkin’s disease, non-Hodgkin lymphoma, breast cancer, and gastrointestinal cancer. Validated QOL scales were used: Decision Regret Score (DRS), Satisfaction with Life Scale (SWLS), and World Health Organization QOL BREF (WHOQOL-BREF). Results 560 women (61%) whose treatment could affect fertility were counseled by the oncology team, 45 (5%) were counseled by fertility specialists, 36 (4%) took action to preserve fertility. Pre-treatment infertility counseling by a fertility specialist and an oncologist resulted in lower regret than counseling by an oncologist alone (8.4 vs. 11.0, P<0.0001). The addition of fertility preservation (6.6 vs. 11.0, P<0.0001) was also associated with even lower regret scores than counseling by an oncologist alone.. Further improvements were similarly seen in SWLS with the addition of fertility specialist counseling (23.0 vs. 19.8, P=0.09) or preserving fertility (24.0 vs. 19.0, P=0.05). Conclusions Receiving specialized counseling about reproductive loss and pursuing fertility preservation is associated with less regret and greater QOL for survivors, yet few patients are exposed to this potential benefit. Reproductive aged women should have expert counseling and be given the opportunity to make active decisions about preserving fertility.

Background We sought to describe the age-specific impact of infertility and early menopause after chemotherapy, among reproductive age women with cancer. Methods 1041 women diagnosed with cancer between the ages of 18 and 40 responded to retrospective survey on reproductive health history. Five cancer types were included: leukemia, Hodgkin’s disease (HD), non-Hodgkin lymphoma (NHL), breast cancer, and gastrointestinal cancer (GI). Survey questions addressed: AOF (cessation of menses after treatment), early menopause (menopause prior to 45 years old) and infertility (failed conception). Logistic regression was used to determine the proportions of AOF and infertility based on age at diagnosis. Censored data methods were used to determine the probability of early menopause. Results 620 women received chemotherapy alone. The percentage reporting AOF was 8%, 10%, 9%, and 5% for HD, NHL, breast cancer, and GI, respectively. AOF increased significantly with age at diagnosis (p<0.05). If not in AOF, the incidence of infertility was at least 40% at age 35 and increased significantly with age at diagnosis in HD and breast cancer (p<0.05). The estimated probability of early menopause was at least 25% at age 30 and increased significantly with younger age at diagnosis in HD, NHL, and GI (p<0.05). Conclusions In order to give patients appropriate counseling, it is important that they understand the potential increased risk of infertility and early menopause beyond that of acute ovarian failure. These findings can provide improved, age-specific counseling regarding reproductive impairment for young women diagnosed with cancer.

Background This study seeks to examine the relationship between socio-demographic characteristics and the utilization of fertility preservation services in reproductive age women diagnosed with cancer. Methods 1041 women diagnosed with cancer between age 18 and 40 responded to our retrospective survey on demographic information and reproductive health history. Five cancer types were included: leukemia, Hodgkin’s disease (HD), Non-Hodgkin Lymphoma (NHL), breast cancer, and gastrointestinal cancer (GI). 918 women reported treatment with potential to affect fertility (chemotherapy, pelvic radiation, pelvic surgery, or bone marrow transplant). Student’s t-test, linear regression, and multivariate logistic regression were used where appropriate to determine the relationship between socio-demographic characteristics and the odds of utilizing fertility preservation services. Results 61% of women were counseled on the risk of cancer treatment to fertility by the oncology team. Overall, 4% of women pursued fertility preservation. In multivariate analysis, women who had not attained a bachelor’s degree (OR 0.7, 95%CI 0.5 – 0.9) were less likely to be counseled. Trends also suggested possible disparities in access to fertility preservation with age greater than 35 years old (OR 0.1, 95% CI 0.0 – 1.4) or previous children (OR 0.3, 95% CI 0.1 – 1.1) at diagnosis. Disparities in access to fertility preservation based on ethnicity and sexual orientation were also observed. Conclusion Socio-demographic health disparities likely affect access to fertility preservation services. Although awareness of fertility preservation has improved in the last decade, an unmet need remains for reproductive health counseling and fertility preservation in reproductive age women diagnosed with cancer.

Many women may not receive adequate information about RHRs or FP at the time of cancer diagnosis. Advancements in reproductive technology and emerging organizations that cover financial costs of FP have dramatically changed what options women have to preserve their fertility. Routine and thoughtful RHR and FP counseling, as well as collaborative cancer care will help ensure that women diagnosed with cancer are provided with the services and information they need to make an informed choice about their reproductive future.

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