Fertility preservation and cancer

Abstract

Purpose of review With increasing survival rates, fertility is an important quality of life concern for many young cancer patients. There is a critical need for improvements in clinical care to ensure patients are well informed about infertility risks and fertility preservation (FP) options and to support them in their reproductive decision-making prior to treatment. Recent findings A number of barriers prevent fertility from being adequately addressed in the clinical context. Providers’ and patients’ incomplete or inaccurate understanding of infertility risks exacerbate patients’ reproductive concerns. For female patients in particular, making decisions about FP before treatment often leads to decision conflict, reducing the likelihood of making informed, values-based decisions, and post-treatment regret and distress. Recent empirically-based interventions to improve provider training around fertility issues and to support patient decision-making about FP show promise. Summary Providers should be knowledgeable about the infertility risks associated with cancer therapies and proactively address fertility with all patients who might one day wish to have a child. Comprehensive counseling should also include related issues such as contraceptive use and health implications of early menopause, regardless of desire for future children. Although the negative psychosocial impact of cancer-related infertility is now well accepted, limited work has been done to explore how to improve clinical management of fertility issues in the context of cancer care. Evidence-based interventions should be developed to address barriers and provide psychosocial and decision-making support to patients who are concerned about their fertility and interested in FP options.

Adolescent and Young Adult (AYA) Cancer Survivorship Practices: An Overview

“…Although some patients of younger ages may feel as if fertility is not relevant to them yet, it is important though to discuss the possibility of infertility, as it may have a huge impact later in life [16,64]. Unfortunately, despite the availability of fertility preservation options (e.g., embryo, oocyte, or ovarian tissue cryopreservation and hormonal therapies for women, or testicular tissue cryopreservation and sperm banking for men), the understanding of fertility risks may either not be complete or accurate, or the experience of discomfort among healthcare providers or patients may lead to the start of treatment without fertility preservation or fertility concerns among patients [16,31,46,[65][66][67][68]. From the perspective of AYA survivors and their families, common barriers to fertility care include the lack of high-quality information regarding fertility risk and preservation, concerns regarding treatment delay, and concerns about the health of the AYA and their offspring.…”

Fertility preservation training for obstetrics and gynecology fellows: a highly desired but non-standardized experience

“…Young survivors consistently identify desire for future fertility as among the most significant concerns following a cancer diagnosis [ 1 – 4 ]. Heightened anxiety about fertility has been shown to negatively correlate with perceived quality of life among cancer survivors [ 5 ], whereas availability and uptake of fertility preservation services prior to treatment has been shown to increase psychosocial well-being and avoid long-term regret in patients diagnosed with cancer [ 6 – 10 ].…”

Efficacy of Video-based Education in Improving Understanding of Pediatric Fertility Preservation

“…Previous research has shown that there are barriers to making decisions about FP in the pediatric population, including a lack of understanding of the options available. [38][39][40]43 Video-based educational tools may help to address the barriers to FP. Specifically, in this study, viewing videos increased parent and patient knowledge and understanding about pediatric FP and, therefore, may reduce distress surrounding the decision, which has previously been correlated with poor understanding.…”

“…38 This may lead to higher levels of decisional conflict and regret. [38][39][40] Poor understanding of FP has also been correlated with higher levels of distress. 41,42 Within the literature, common barriers to FP decisions include how information is presented and a lack of understanding of the FP options available.…”