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Fertility is an important quality of life issue for cancer patients of child-bearing age. Some types of cancer treatments (especially certain forms of chemotherapy and with radiation to the pelvis) can impair fertility. Such patients may benefit from referral to a reproduction specialist before they start their cancer treatment. Unfortunately, the majority of studies show that less than half of eligible cancer patients actually receive this information and thus are rendered infertile (sterile) for the remainder of their life. One can understand that at the onset of a cancer diagnosis that the primary focus is on a life-threatening situation. The dilemma comes later, when patients are actually enjoying a long-term life and these survivorship issues then become paramount.
Many cancer patients interested in fertility preservation prefer to have biological children rather than adopt or use third party reproduction. Studies of cancer patients report that loss of fertility is of immense concern that can cause great distress. The American Society of Clinical Oncology (ASCO) and the American Society for Reproductive Medicine (ASRM) have developed guidelines on this issue. These guidelines suggest that oncologists “should address the possibility of infertility with patients treated during their reproductive years and be prepared to discuss possible fertility preservation options or refer appropriate and interested patients to reproductive specialists”. Addressing this issue with patients is an important aspect of quality cancer care.
With advances in reproductive biology and technology, fertility preservation methods are now available that allow some cancer patients to preserve fertility before treatment. Sperm cryopreservation is the primary option available to males and has high likelihood of success. For women, fertility preservation issues are more complex. Embryo cryopreservation is the most established option, which involves fertilization of egg with sperm through in vitro fertilization. Egg freezing, an experimental option, is typically used in women who do not have a partner or do not wish to use a donor sperm.
In a recent article published in the Journal of Clinical Oncology (JCO, volume 27: [page 5952, 2009), Dr. Guinn and colleagues conducted a national study about fertility preservation and physician attitudes. Forty-seven percent of 516 physician respondents routinely refer their cancer patients of child-bearing age to a reproductive specialist. Referrals were more likely when patients routinely asked about fertility preservation, and also when among female physicians and those with a favorable attitude towards fertility preservation. On the other hand, half of the physicians are not referring patients.
Not all drugs cause problems with ovulation or sperm viability… others do. Discuss it with your doctor. Remember that radiation to the pelvis may also result in sterility (but not if radiation is given to other parts of the body). If you are interested in pursuing this, ask your doctor to refer you to a reproductive specialist. Studies have found that banking sperm or embryos was viewed as a positive factor to help patients cope with their disease, even if they never used them in the future.
The most important message for those of you reading this blog who are of child-bearing age… or who are a partner or care-giver of a cancer patient of child-bearing age: please discuss fertility options with your oncologist!
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