One of the devastating effects of cancer and its treatment is its permanent effect on a patient’s fertility. When a child or young adult, in particular, experiences a cancer diagnosis, getting life-saving treatment—as opposed to the decision to have children later in life—is the priority. However, the future fertility of patients should be addressed during the time when treatment options are discussed.
Who should bring this topic up to patients and their families before treatment? Medical oncologists, radiation oncologists, gynecologic oncologists, urologists, hematologists, pediatric oncologists, and surgeons, as well as nurses, social workers, and psychologists, should have this on their check-list of topics to discuss prior to treatment, resulting in a multi-faceted approach to healing and survivorship.
In alignment with this thought process, in 2013 the American Society of Clinical Oncology (ASCO) updated its 2006 clinical practice guideline on fertility preservation. One of the updates to the guideline was the change from the word “oncologist” to “health care provider”, which was meant to broaden the scope of the medical personnel who should help patients understand their fertility preservation options.1
Given that this topic can be a challenge to address, the topic should be broached with parents of children with cancer and directly with adults who are of childbearing age, even if they express ambivalence. Some patients may not yet have considered whether or not they want to have children in the future, and it may be difficult for a person facing cancer treatment to suddenly need to make another life-altering decision. Yet, it is critical to address and ensure that patients understand all of their options.
Preserving a Future Family
For adult women, cancer treatment can lead to infertility or early menopause. The established fertility preservation methods are embryo and oocyte cryopreservation. Women who will undergo pelvic radiation therapy as part of treatment should know about ovarian transposition or oophoropexy, which moves the ovaries outside of the radiation field to reduce radiation exposure.2 Patients may ask about other methods; however, there is not enough evidence to support the effectiveness of techniques, such as ovarian suppression with gonadotropin-releasing hormone analogs, as a fertility preservation method, and it should not yet be relied on to preserve fertility. For girls who have reached sexual maturity, oocyte cryopreservation is an option. For girls who have not reached puberty, methods such as ovarian tissue cryopreservation for future transplantation are still experimental, according to ASCO’s guideline.
For adult men and adolescent males who have reached sexual maturity, chemotherapy can potentially cause genetic damage to sperm. The established fertility preservation is semen cryopreservation (sperm banking). Hormonal therapies are not recommended for fertility preservation, and other methods (eg, testicular tissue cryopreservation, which does not require sexual maturity, for future reimplantation or grafting of human testicular tissue) are considered experimental.
Clinical Tools and Resources
ASCO has a wealth of resources related to fertility preservation in the Guidelines section of their website. In addition, ASCO’s patient website, Cancer.Net has helpful information such as a fertility preservation infographic that helps patients learn, at-a-glance, what their options might be.
Cancer is a life-altering experience for patients; however, so is infertility. Oncology professionals should always do their best to ensure that patients and their families have all the decision-making tools available.
- Loren AW, Mangu PB, Beck LN, et al. Fertility preservation for patients with cancer: American Society of Clinical Oncology clinical practice. J Clin Oncol. 2013;31(19):2500-251010.
- Knopman JM, Noyes N. Mitigating the risk: the role of ovarian transposition and medical suppression. In: Gracia C, Woodruff TK, eds. Oncofertility Medical Practice Clinical Issues and Implementation. Chicago, IL: The Oncofertility Consortium at Northwestern University; 2012:91-104.