Fertility preservation consultation for women with cancer: are we helping patients make high-quality decisions?

Abstract

To investigate the efficacy of the current fertility preservation consultation process in patients' decision-making and socio-demographic and cognitive factors that may affect patients' decision-making, a prospective pilot survey was conducted at university-based IVF centres and included women aged 18-43 years seen for fertility preservation between April 2009 and December 2010. Patients' views on consultation and decision-making about fertility preservation were measured. Among 52 women who completed the survey, more than half (52%) requested their consultation. All patients answered that consultation was a helpful resource of information, and 73% made their decision about treatment after consultation. Decisional conflict was lower in patients who felt strongly that they were given opportunities to ask questions during the consultation (P=0.001) and higher those who reported that cost was strongly influential in the treatment decision (P<0.001) and who did not receive treatment (P<0.001). Although consultation appeared to play a critical role in patients' decision-making about fertility preservation, the referral rate for consultation by oncologists is still poor. Decision-making appears to be significantly impaired in patients grappling with financial concerns and when the opportunity to ask questions is not felt to be sufficient.

Feasibility and effects of a decision aid about fertility preservation

“…Therefore, the benefit of any additional information with regard to knowledge and feeling supported in DM about FP is clear . However, besides additional written information, referral to a fertility expert for counselling about FP is still of utmost importance (Kim et al, 2013). Indeed, the information in the DA could be a good addition to information received by the gynaecologist, as suggested by our finding that women who were recruited through their gynaecologist (and hence had already received some information on FP) still had similar relative increases in knowledge between measurement moments, when compared to women recruited by their oncologist.…”

An evaluation of the Gifu Model in a trial for a new regional oncofertility network in Japan, focusing on its necessity and effects

“…The percentage of oncologists who indicated that they understood the preservation treatments for gamete, embryo and ovarian tissues were 60, 30, and 5 %, respectively major issue in the treatment of young patients with cancer. Previous reports show that a threat to future fertility is a significant concern for cancer survivors [3,6,8,9]. Despite the heightened awareness of fertility preservation and the increasing number of patients who are referred to fertility preservation specialists, only a small percentage of patients elect to receive treatment [4,8,10].…”

“…Previous reports show that a threat to future fertility is a significant concern for cancer survivors [3,6,8,9]. Despite the heightened awareness of fertility preservation and the increasing number of patients who are referred to fertility preservation specialists, only a small percentage of patients elect to receive treatment [4,8,10]. This suggests that making decisions about fertility preservation is a complex process for many young patients with cancer.…”

Ovarian stimulation and in-vitro fertilization outcomes of cancer patients undergoing fertility preservation compared to age matched controls: a 17-year experience

“…It is well established that cryopreservation of embryos and, more recently oocytes [11], are feasible options for young women facing potentially gonadotoxic cancer treatment who wish to have genetically related children in the future, but a paucity of data exists to facilitate patient counseling in terms of outcomes [3,4,9,[12][13][14]. The aim of this study is to compare the ovarian stimulation and IVF outcomes, most notably total dose of gonadotropins used, number of oocytes retrieved, and number of 2pn embryos obtained, for cancer patients who underwent embryo cryopreservation prior to gonadotoxic treatment to those of an age-matched comparison group with tubal infertility who underwent a fresh IVF cycle within the same three-year period as the cancer patient.…”