Fertility preservation for medical reasons in girls and women: British fertility society policy and practice guideline

Abstract

Fertility preservation in the female poses several challenges due to the invasive nature of the techniques available to achieve it. The guideline aims to bring together the evidence available for the measures for fertility preservation and their outcome. The guideline addresses fertility preservation for medical reasons and includes both oncological and non-oncological causes. The techniques that the guideline considers are: (i) embryo and oocyte cryopreservation; (ii) ovarian tissue cryopreservation; (iii) GnRH agonist suppression and (iv) ovarian transposition. Although ovarian tissue cryopreservation is still considered experimental, the availability of this technique is gaining momentum as more live births from auto-transplanted tissue are reported. The guideline also highlights use of current treatment modalities for benign and malignant conditions that have a better fertility sparing profile. The guideline recommends a multidisciplinary approach in counselling women and girls about the risk to their fertility and available techniques. The role of psychological support in assisting women and girls with decision-making is highlighted. The guideline also highlights the risks associated with these techniques. Women need to be medically fit to undergo invasive procedures. Fertility preservation techniques are appropriate when treatment has curative intent. Fertility preservation is a subject of on-going research on outcomes of different techniques and at the time of publication, studies are still likely to emerge adding to the available literature.

A prospective study of women and girls undergoing fertility preservation due to oncologic and non‐oncologic indications in Sweden–Trends in patients’ choices and benefit of the chosen methods after long‐term follow up

“…According to current international guidelines, young adults and children diagnosed with cancer should receive timely reproductive counseling early in the process of scheduling treatments with a potentially negative impact on their reproductive health and, in selected cases, emergency treatments aimed at saving fertility potential for the future should be offered . Current standards of care also recommend counseling for patients with benign conditions associated with early onset gonadal insufficiency and similar fertility preservation (FP) options …”

The psychological importance of fertility preservation counseling and support for cancer patients

“…Most recommendations are for counseling at the time of cancer diagnosis or initial fertility treatment commencement, opposed to fertility support after oncological treatment. Some guidelines reference childhood cancer survivors, or give mention to the benefit of follow‐up counseling after oncological treatment . However, there are reported differences on when these follow‐up consultations should occur; eg based on medical treatment time‐point, patient family planning preferences or patient levels of infertility distress.…”

“…However, fertility counseling by way of medical information provision is a different concept to fertility counseling, being the therapeutic exploration of reproductive concerns and fertility treatment needs by a clinician with mental health training . Counseling by mental health clinician or the importance of psychological support was only noted within one‐third of the guidelines or recommendation documents. Some purely note the detrimental psychological effects of infertility or psychological impact when counseling is inadequate, without providing further recommendations for how psychological counseling should then be implemented .…”

“…For those cancer patients who have yet to complete their family at the time of their cancer diagnosis, impacted fertility causes a disruption to family planning. As such, there are currently multiple fertility preservation international guidelines that advocate for timely discussion, referral to fertility specialist, and access to fertility preservation and counseling for cancer patients of reproductive age; including adolescents and young adults . Fertility preservation practices include surgical procedures which allow for gonadal tissue or gametes to be cryopreserved and allow patients the opportunity to have a biological child after completing oncological treatment.…”

Focus on fertility preservation

“…In this paper, Yasmin et al (2018) propose a number of recommendations for UK practice. They also remind us that fertility preservation is not just an issue for oncologists and cancer patients but should be a routine part of care in all areas of medicine where the premature loss of fertility is a major threat.…”