Fertility preservation in oncology patients: A literature review examining current fertility preservation techniques and access to oncofertility services in Australia

Abstract

Background In Australia, between the years 2010 and 2014, over 4500 adolescents and young adults (15–25 years old) were diagnosed with cancer. Treatment regimens are often gonadotoxic and are well known to induce ovarian and testicular failure. Oncofertility is an emerging discipline in obstetrics and gynaecology which seeks to preserve and restore the reproductive future of cancer patients. Aim To perform a systematic literature review to assess the current fertility preservation techniques available to patients and examine access and uptake of fertility preservation in Australia. Materials and Methods Electronic databases, including Medline, Cochrane Review, SCOPUS and CINHAL, were searched for peer‐reviewed publications and national guidelines examining oncofertility practices from 2008 to July 2018. Three hundred and seventy‐five articles were initially screened, with 158 articles for full text review and an additional five clinical guidelines were identified. Results There is a paucity of Australian data on oncofertility with <50% of data included for analysis reflecting the Australian experience. The majority of primary research included retrospective papers with small cohort numbers. Key areas addressed included live birth outcomes, uptake of services and patient and physician perspectives on fertility preservation. Few articles sought to examine the positive and negative side effects of fertility preservation in oncology, social challenges of oncofertility and access to services worldwide. Conclusion Oncofertility is an emerging discipline which seeks to provide safe, efficient and effective fertility preservation options for young adults and adolescents diagnosed with cancer. A multi‐disciplinary approach with collaborative communication with oncologists is key to providing this service within Australia.

The Australian Youth Cancer Service: Developing and Monitoring the Activity of Nationally Coordinated Adolescent and Young Adult Cancer Care

“…The risk of infertility is identified by cancer patients as one of the top unmet needs in survivorship [ 37 , 38 ], resulting in fertility-related distress, including increased risks of depression, anxiety and grief, and contributes to reduced relationship satisfaction and quality of life [ 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 ]. Despite this, there is often limited knowledge and discussion of cancer-related fertility issues across the cancer trajectory, and little awareness of and access to fertility preservation services and reproductive survivorship care [ 43 , 48 , 49 , 50 , 51 , 52 , 53 ]. In identifying oncofertility as a priority area for the YCS, the NSDF and AYCF specified that quality care would result in AYAs being aware of potential impacts of treatment on fertility, and of fertility preservation options [ 6 , 7 ].…”

Fertility preservation in gynaecology oncology patients: Experience from an Australian tertiary oncology centre

“…Despite multiple available hospitals within the referral pathway of the analysed tertiary centre, private referrals were still more common. Improvements in referral pathways, access to care and education and awareness of clinicians regarding the available public services would be of significant benefit to patients in the public healthcare system and ideally improve the uptake of these services 14 . The importance of this has been recognised by the government with new initiatives aimed at encouraging growth of public‐based fertility services.…”

“…Improvements in referral pathways, access to care and education and awareness of clinicians regarding the available public services would be of significant benefit to patients in the public healthcare system and ideally improve the uptake of these services. 14 The importance of this has been recognised by the government with new initiatives aimed at encouraging growth of public-based fertility services. Future Fertility has also made improvements in care establishing a dedicated oncofertility centre in Australia.…”

Current Status of Fertility Preservation in Pediatric Oncology Patients

“…Suzuki et al [14] discuss the development of Japanese guidelines for child fertility preservation, drawing from both domestic experiences and international initiatives. Robson et al have examined the current state of affairs in Australia, revealing disparities in access across different health-care facilities, with up to 26% of families unable to access preservation services due to financial constraints [15].…”