Gender-specific aspects related to type of fertility preservation strategies and access to fertility care

Abstract

Survivorship is an area of paramount importance to be addressed as early as possible after cancer diagnosis by all health care providers. On this regard, cancer care in young patients often poses several age-related considerations among which fertility and pregnancy-related issues have a crucial role. According to the available guidelines on the topic, all patients with cancer diagnosed during their reproductive years should be provided a proper oncofertility counselling before starting anticancer treatments. This is an important step in order to inform patients about the potential treatment-induced gonadotoxicity and the available strategies for fertility preservation so that they can be referred as early as possible to fertility specialists if potentially interested in these options.In this manuscript, we aim to provide an up to date overview on the available efficacy and safety data with the main strategies for fertility preservation in male and female cancer patients in order to help optimising the oncofertility counselling performed by healthcare providers involved in cancer care and dealing with young patients. In male patients with cancer, sperm cryopreservation is the standard technique for fertility preservation. Oocyte/embryo cryopreservation, ovarian tissue cryopreservation and temporary ovarian suppression with luteinising hormone-releasing hormone agonists during chemotherapy are the main options in female patients with cancer.A multidisciplinary management building a strong network between fertility and oncology/haematology units is crucial to properly address fertility care in all young patients with cancer, at both diagnosis and during oncologic follow-up. Discussing fertility and pregnancy-related issues with young patients with cancer has to be considered mandatory nowadays keeping in mind that returning to a normal life (including the possibility to have a family and to live with as few side effects as possible) should be considered an important ambition in cancer care in the 21st century .

How I perform fertility preservation in breast cancer patients

“…Nowadays, giving hope for a family after cancer diagnosis and treatment should be considered a crucial ambition in cancer care. 14 Therefore, oncofertility care has become a priority and a mandatory component of the management of young women with newly diagnosed breast cancer. 2 , 3 Increased awareness by all health care professionals in oncology is needed to make sure this topic is always discussed at diagnosis and women can make fully informed decisions about the proposed anticancer therapies and their potential interest in accessing the available strategies for ovarian function and/or fertility preservation.…”

Female Oncofertility: Current Understandings, Therapeutic Approaches, Controversies, and Future Perspectives

“…The live birth rate is reported after oocyte cryopreservation to range from 32.6% [ 105 ] to 42.1% [ 106 ]. Per oocyte, the live birth rates were 8.7% (women < 30 years) and 1.1% (women 43–44 years) [ 107 ]. Recent data indicate that having 10–12 oocytes leads to reasonable cumulative live birth rates up to 61.9% and 43.4% in patients <35 years of age and ones >35 years of age, respectively [ 106 , 108 ].…”

“…In a large series report from five leading European centers, the live birth rates were 30% and 21%, respectively, among those conceiving naturally and those undergoing in vitro fertilization (IVF) with a low rate of malignant relapse [ 80 ]. In general, the live birth rate is reported to be about 40% among survivors who are <36 years of age [ 107 ]. Consequently, the updated guidelines of the ASRM and ESHRE recommend that OTC should be considered as an established procedure to be offered to selected patients for FP purposes [ 127 , 128 ].…”

Knowledge, Practice, and Attitudes of Physicians in Low- and Middle-Income Countries on Fertility and Pregnancy-Related Issues in Young Women With Breast Cancer

“…[15][16][17] Well-established models of care in oncofertility exist to help physicians in dealing with these issues. 18,19 However, knowledge, practice, and attitudes of breast cancer specialists toward management of fertility and pregnancy-related concerns in young patients are not always optimal. 20 In our prior survey, the majority of responders were from Western countries, with only a minority of responding physicians practicing in LMICs.…”