Many Cancer Patients Are Not Receiving Information About Fertility Preservation

Source: CBS News – July 27, 2015

A study in the journal Cancer revealed that, although 70% of patients learned cancer treatments like chemotherapy could cause infertility, only 31% of men and 6.8% of women surveyed used fertility-preserving options.

Researchers polled 459 teen and young adult cancer patients from seven different registries across the U.S. about fertility preservation counseling and strategies they had received prior to treatment. They found men were more than twice as likely to not take fertility-preserving measures if they did not have a medical oncologist, and were nearly three times as likely to not preserve their fertility if they did not have insurance. Women surveyed were over five times as likely not to preserve their fertility if they did not have insurance, and the researchers noted too few women in the study had made fertility-preserving arrangements to make other, similar comparisons with the men they surveyed.

Oncologists and fertility specialists face significant challenges in counseling adolescent and young adult patients with cancer who may not be considering family planning at a younger age. Other barriers to fertility preservation include cost of fertility preservation procedures, lack of insurance coverage, and potential delay to treatment. Oncologists may also not be aware of the latest fertility-preserving techniques. Oncologists and fertility specialists should work together to increase awareness of fertility-preserving options for all patients with a cancer diagnosis interested in current or future family building.

Usually, the last thing on a teenager’s mind is fertility preservation. Some adolescents and young adults may think about the fact they wanted to be parents, but overall that’s not usually their first concern. Oncologists, reproductive endocrinologists, and parents need to have that initial conversation. It might be overwhelming at the time, but it’s very important to talk about fertility preservation beforehand so that these young men and women know their options. In this situation, preserving one’s fertility is one thing patients can have some control over, and that’s very powerful when faced with a cancer diagnosis.
The younger someone is prior to chemotherapy, the more likely it is that ovaries and sperm will recover. A person’s options will depend on the diagnosis, how sick they are, how much time they have before beginning cancer treatment, and the type of cancer treatment. Depending on the treatment—the kind of chemotherapy or radiation they’re getting—it could render them incapable of having a family. That is something that has been shown to cause significant regret and depression later in life.

When patients with a cancer diagnosis come to us with fertility preservation needs, we need to act quickly and be able to accommodate them. We are typically available within 24 to 48 hours of a patient reaching out to us or after a referral from an oncologist—in many cases, we will be able to see patients even sooner than that. During a consult, I review all of the available options, and if they’re interested, I will call their oncologist directly to talk about the treatment planned, how much time we have for fertility preservation options, and whether they think it’s safe for the patient.

In terms of treatment options for post-pubertal men, RADfertility offers sperm freezing, and we also work with urologists to coordinate testicular biopsies and freezing. Unfortunately, we do not have the ability to do pre-pubertal testicular biopsy and freezing; this is an experimental procedure and should be done at one of the few academic centers with a research protocol for that technology.

For young women, we offer egg freezing as the primary fertility preservation option. If they have a partner, embryo freezing may also be an option. RADfertility will offer ovarian tissue freezing once we receive IRB approval to use the technology. Until then, we have colleagues at other centers who are able to perform ovarian tissue freezing immediately.
Patients who have already undergone cancer treatment may still have ovarian or testicular function and may be able to conceive on their own. If they are not able to conceive on their own, the options available to them are donor egg, donor sperm, or donor embryo.

At our office, we have the ability to get started the same day as a consult, or the following day thanks to our excellent IVF coordinators, nursing staff, and support staff who are able to effectively accommodate these patients. We coordinate with a patient’s schedule and want to know that they feel comfortable moving forward. RADfertility is part of the Oncofertility Consortium, a group of oncologists and reproductive endocrinologists that offer fertility preservation to patients across the country. Patients can visit the website for information and no matter where they are in the country, they can find the center that’s closest to them.