Variability in the Practice of Fertility Preservation for Patients with Cancer

Abstract

Fertility is important to women and men with cancer. While options for fertility preservation (FP) are available, knowledge regarding the medical application of FP is lacking. Therefore we examined FP practices for cancer patients among reproductive endocrinologists (REs). A 36 item survey was sent to board-certified REs. 98% of respondents reported counseling women with cancer about FP options. Oocyte and embryo cryopreservation were universally offered by these providers, but variability was noted in reported management of these cases—particularly for women with breast cancer. 86% of the respondents reported using letrozole during controlled ovarian stimulation (COS) in patients with estrogen receptor positive (ER+) breast cancer to minimize patient exposure to estrogen. 49% of respondents who reported using letrozole in COS for patients with ER+ breast cancer reported that they would also use letrozole in COS for women with ER negative breast cancer. Variability was also noted in the management of FP for men with cancer. 83% of participants reported counseling men about sperm banking with 22% recommending against banking for men previously exposed to chemotherapy. Overall, 79% of respondents reported knowledge of American Society for Clinical Oncology FP guidelines—knowledge that was associated with providers offering gonadal tissue cryopreservation (RR 1.82, 95% CI 1.14–2.90). These findings demonstrate that RE management of FP in cancer patients varies. Although some variability may be dictated by local resources, standardization of FP practices and communication with treating oncologists may help ensure consistent recommendations and outcomes for patients seeking FP.

Impact of letrozole supplementation during ovarian stimulation for fertility preservation in breast cancer patients

“…This strategy of ovarian stimulation enables a follicular maturation while maintaining serum E 2 levels close to the normal ranges [5,18]. Therefore, COSTLES protocol now represents the preferred option for most of oncofertility specialists in case of estrogen-sensitive diseases [7,19], even though robust data to support an actual oncologic risk related to conventional stimulation protocol is lacking [20].…”

“…Therefore, specific protocols have been developed, in order to combine multiple follicular growth throughout exogenous FSH administration, while limiting the effect of hyper-estradiolemia or maintaining serum E 2 levels within the normal ranges [5]. Hence, COS with anti-aromatase (AI) supplementation [6] is now largely used for BC patients seeking FP [7]. Nevertheless, few data have compared, in BC patients, the results obtained with conventional GnRH antagonist protocols and controlled ovarian stimulation with letrozole supplementation (COSTLES) [8,9].…”

Fertility preservation practices in pediatric and adolescent cancer patients undergoing HSCT in Europe: a population-based survey

“…The availability of a standardized program is known to enhance the application of existing recommendations and implementation of FP procedures before treatment start and/or before HSCT; such a program may also facilitate patients' decision making about FP. 9 The absence of an SOP significantly increases the risk of variability of practices 17 and could present a barrier to counseling. Ideally, in the FP process, the pediatric hematologist/oncologist, as a treating doctor, has a central role; this pivotal role requires the proper management of information with the patient and his/her family.…”

Ovarian stimulation in the luteal phase: systematic review and meta-analysis

“…The objective of the systematic review was to summarize the available evidence and encourage continued research on this important and timely topic. Dissemination of such information is critical as our group has demonstrated that fertility preservation practices are variable among Reproductive Endocrinologists [39]. Although the meta-analysis contains significant clinical and statistical heterogeneity, this method of quantitative analysis is reasonable when only observational data exists.…”

“…Dissemination of this information is important as application of fertility preservation strategies vary widely [39]. More work is needed before luteal phase starts are applied broadly in the general infertility population, but they do have potential in improving convenience of ART.…”