This study provided insight into factors associated with tamoxifen use for reproductive-aged breast cancer survivors, with a new focus on fertility. Fertility concerns negatively impacted tamoxifen initiation and continuation among premenopausal patients. Interventions to optimize treatment initiation and persistence for young cancer patients should include access to fertility preservation options.

The overall incidence of bowel injury in gynecologic laparoscopy is 1 in 769 but increases with surgical complexity. Delayed diagnosis is associated with a mortality rate of 1 in 31.

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Background and Objectives Breast cancer treatment can cause premature ovarian failure, yet the majority of young cancer patients do not receive adequate education about treatment effects before initiating chemotherapy. We studied the impact of an oncofertility program on access to fertility preservation. Methods An oncofertility program was initiated to foster collaboration between oncologists and reproductive endocrinologists, and to help increase access to fertility preservation. Documented conversations about fertility concerns, specialist referrals, appointments, and fertility preservation procedures were compared between breast cancer patients from 2004 to 2006, before oncofertility program initiation, and 2007–2012, after program initiation. The study included women <45, stages 0–III, diagnosed before (n =278) and after (n =515) program initiation. Results Demographics for the cohorts were similar. Fertility discussions (P <0.0001), patients interested in maintaining fertility at diagnosis (P =0.0041), referrals to reproductive endocrinologists (P <0.0001), appointments (P <0.0001), and fertility preservation procedures (P <0.0183) increased significantly after programmatic implementation. Conclusions An oncofertility program increased discussions about fertility preservation and access to assisted reproductive procedures. This program positively impacted compliance with national guidelines advising reproductive-age cancer patients to be offered fertility preservation counseling as an initial component of the multidisciplinary care plan.