Fertility Protection in Female Oncology Patients: How Should Patients Be Counseled?

Abstract

Protecting the fertility of patients with oncologic disease is becoming more and more important, as fulfilling the wish to have children is increasingly occurring at a later stage in life and long-term survival rates after cancer are continuing to improve. A number of fertility-preserving options exist. In addition to techniques which have been around for some time such as medical ovarian suppression, ovarian transposition, and organ-preserving surgery, there are other, more recent, innovative methods which have developed over the last few years such as cryopreservation of oocytes or ovarian tissue transplantation after completing cancer therapy. As every procedure has its specific advantages and disadvantages, informed patient consent is essential. The physician?s aim must be to select the optimal procedure for each patient. The extent of patients? information about the options to preserve fertility in women with oncologic disease remains limited. One of the main reasons for this is that clinicians are not sure how to inform patients about existing procedures and methods. The aim of this review article is to provide help in clinical practice.

Knowledge about and attitude towards fertility preservation in young female cancer patients: a cross-sectional online survey

“…As a consequence of their therapy however, women who are treated for cancer during their reproductive life span might be confronted with impaired fertility (Angarita, Johnson, Fader, & Christianson, 2016;Findeklee et al, 2015). The number of fertility preservation (FP) options is increasing.…”

The origin of a chart indicating the likelihood of conception linearly declining with age: a literature survey

“…Not only has it been the case in the United States (Phillips and Grifo 2016: 7), but there are also cases of these figures being quoted in a German academic journal (Findeklee et al 2015(Findeklee et al : 1244Müller et al 2009: R69). In Japan Yamagata (2013: 177-82) provides an example of abusive usage: an educational use of the chart to encourage young women to get pregnant earlier.…”

“…It has also been publicized through a book (Phillips and Grifo 2016: 7) jointly written by Kyra Phillips, a news anchor of Cable News Network (CNN), and Jamie Grifo, the program director of New York University Fertility Center (with a modification in the horizontal axis scale). It has even been featured in an article published on an academic journal (Findeklee et al 2015(Findeklee et al : 1244. Figure 1 would have a great impact on people who are seeking information for decision-making regarding the feasibility of their efforts toward fertility.…”

Pregnancy in the liver transplant recipient

“…Clinicians should recognize the possibility of an in vitro treatment that may result in a successful pregnancy, even when both partners have undergone transplantation procedures . In the case of patients who are expected to receive gonadotoxic treatment, it is advisable to present current fertility preservation techniques such as transposition of the ovaries away from the area targeted for radiation, ovarian suppression using gonadoliberin (GnRH) analogues such as goserelin and leuprorelin acetate, or cryopreservation of oocytes or ovarian tissue …”