Perceived infertility and contraceptive use in the female, reproductive-age cancer survivor

Abstract

Objective: To estimate the association between perceived fertility potential and contraception use and to characterize factors important in contraceptive decision making in reproductive-age, female cancer survivors. Design: Cross-sectional study. Setting: Participants were from two state cancer registries, physician referrals, and cancer survivor advocacy groups in the United States. Patient(s): A total of 483 female survivors aged 18-40 years. Intervention(s): Online questionnaire. Main Outcome Measure(s): Contraception use. Result(s): Eighty-four percent of participants used contraception; 49.7% used highly effective, World Health Organization tiers I and II methods (surgical sterilization, intrauterine devices, contraceptive implant, combined hormonal contraceptives, medroxyprogesterone acetate, progestin-only pills, contraceptive diaphragm). Contraception non-use was more common among survivors who perceived themselves to be infertile, compared with survivors who perceived themselves to be as or more fertile than similarly aged peers (prevalence ratio 4.0, 95% confidence interval 2.5-7.4). In mediation analysis that adjusted for clinical infertility, 59% of the association between prior chemotherapy and contraception non-use was explained by perceived infertility. Contraception efficacy (n ¼ 62, 25.8%) and ease of use (n ¼ 50, 20.8%) were the most cited reasons for using tier I/II methods; compared with lack of hormones (n ¼ 81, 49.7%) as the predominant reason for using less-effective, tier III/IV methods. Conclusion(s): Although female, reproductive-age cancer survivors had high uptake of contraception, those who perceived themselves to be infertile were less likely to use contraception. Throughout survivorship, clinicians should counsel survivors on fertility potential in the context of their prior cancer treatments and on factors, including contraceptive efficacy and hormone-free contraception, that inform reproductive decision making in this population. (Fertil Steril Ò 2019;111:763-71. Ó2019 by American Society for Reproductive Medicine.) El resumen está disponible en Español al final del artículo.

Reproductive intentions in childless female adolescent and young adult cancer survivors

“…A systemic review by Schmidt et al provides an overview of patient-reported concerns regarding post-cancer parenthood, which contribute to decisions to live a childfree life (3). Among the most common concerns were those that involved the child's health, specifically that the child may be at higher risk for cancer themselves or may have poorer health if born after cancer (30)(31). The validity of these medical concerns varies by prior cancer treatment exposures, but most data are reassuring that children born of cancer survivors are not at higher risk of birth defects, chromosomal abnormalities, or childhood cancer (32)(33)(34)(35).…”

Beyond fertility preservation: role of the oncofertility unit in the reproductive and gynecological follow-up of young cancer patients

“…Indeed, in the literature, data suggest that they are less likely to receive adequate contraception counselling, with rates up to 56% of survivors reporting no family planning counselling at all (Castro-Sanchez et al, 2018). Additionally, they are less likely to be satisfied and compliant with the prescribed method (Blouet et al, 2019) and more likely to wrongly assume they are infertile and to face unwanted pregnancies (Medica et al, 2018;Hadnott et al, 2019). Information on contraception during chemotherapy, along with information on fertility preservation, is part of our pre-therapy counselling.…”

Contraception Counseling and Use Among Adolescent and Young Adult Female Patients Undergoing Cancer Treatment: A Retrospective Analysis

“…31e33 Of those survivors with a history of chemotherapy, having the perception of infertility is predictive of contraception nonuse, even without clinical evidence of infertility. 34 As such, discussions about fertility preservation provide an ideal opportunity to provide education about the continued need for contraception.…”