Fertility preservation in cancer patients: The global framework

Abstract

Cancer treatment is the most frequent cause of reduced fertility in cancer patients, with up to 80% of survivors affected. None of the established or experimental fertility preservation methods can assure parenthood; instead it may provide a future opportunity to overcome treatment induced sterility. Previous research demonstrated that fertility counselling has clinical and psychological benefit. Therefore, such patient services are recommended by internationally recognized guidelines. Around 70-75% of young cancer survivors in retrospective studies are reported to desire parenthood but the numbers of patients who use fertility preservation services prior treatment are significantly lower. Moreover, despite existing guidelines healthcare professionals worldwide lack practical knowledge and have personal biases which prevent addressing fertility preservation issues adequately. Surveys of healthcare professionals report the following barriers: lack of time and knowledge about existing options, poor prognosis, and delay in treatment, patient's age, partnership status, existing children, sexual orientation and socioeconomic situation. Moreover, fertility preservation consultation is not limited to medical aspects. Patient's fears, expectations and priorities shaped by personal values have to be addressed in a light of medical necessities, realistic survival prognosis, socio-cultural environment and availability of resources. We call for a need of framework for patient centred fertility counselling with a proposal that such framework should include support in decision making which would help patients to understand medical aspects of their cancer, realistic fertility preservation options, identify their preferences based on personal values and goals. Optional support services could also include legal guidance, psychological and spiritual support and financial counselling.

Adolescent and adult uterine volume and uterine artery Doppler blood flow among subjects treated with bone marrow transplantation or chemotherapy in pediatric age: a case-control study

“…For these biologic reasons, a younger age at radiotherapy seems to protect ovarian function in girls receiving BMT. To simulate a prepubertal hormonal milieu, the administration of gonadotropin-releasing hormone analogues before oncologic treatment of childhood cancer has been proposed as a fertility preservation method (4,5). Although we have no data on this type of treatment, a panel of experts of American Society of Clinical Oncology, after reviewing the data in the literature, recently suggested that gonadotropin-releasing hormone analogues are not an effective method of fertility preservation and that these agents should not be relied on to preserve fertility (27).…”

A Review of the Oncology Patient's Challenges for Utilizing Fertility Preservation Services

“…Linkeviciute et al, 62 Review N = 71 publications Most young cancer survivors desire parenthood. Providing fertility preservations offers these patients a chance to overcome sterility associated with cancer treatment.…”

“…For instance, the lack of an integrated referral system, limited resources or oncofertility specialists to refer patients, and time constraints in early cancer treatment consultations have been identified as possible barriers to timely referrals. 14,20,21,28,43,57,58,61,62 Few institutions have been able to demonstrate a standardized referral process to fertility services for adolescent cancer patients. Institutional policies and appropriate referral to a specialist will help alleviate the concerns oncology providers have expressed in addressing fertility with their AYA patients.…”

Innovative fertility preservation strategies and programs for young adults with cancer

“…Because up to 80% of cancer survivors are at risk for treatment-related infertility, 10 in recent years, national guidelines in many countries have mandated fertility risk assessment and referral for newly diagnosed cancer patients. These include the American Society of Clinical Oncology (ASCO), who published guidelines in 2006 and updated them in 2013, 1 the National Comprehensive Cancer Network (NCCN), 2 the American Society of Reproductive Medicine, the European Society for Medical Oncology, and the European Society of Breast Cancer Specialists.…”

“…These include the American Society of Clinical Oncology (ASCO), who published guidelines in 2006 and updated them in 2013, 1 the National Comprehensive Cancer Network (NCCN), 2 the American Society of Reproductive Medicine, the European Society for Medical Oncology, and the European Society of Breast Cancer Specialists. 10 Per NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines ® ), 2 providers should discuss FP with all eligible patients prior to start of cancer therapy and consider involving a mental health professional to aid in decisionmaking and facilitate coping with the combined threats of infertility and a new cancer diagnosis. Patients interested in preserving fertility should be referred to a specialist within 24 hours.…”