Incorporating fertility preservation into the care of young oncology patients

Abstract

As the number of cancer survivors continues to increase, oncologists are faced with the challenge of providing cancer therapy to patients who may 1 day want to have children. Yet, gonadotoxic cancer treatments can compromise future fertility, either temporarily or permanently. There are established means of preserving fertility before cancer treatment; specifically, sperm cryopreservation for men and in vitro fertilization and embryo cryopreservation for women. Several innovative techniques are being actively investigated, including oocyte and ovarian follicle cryopreservation, ovarian tissue transplantation, and in vitro follicle maturation, which may expand the number of fertility preservation choices for young cancer patients. Fertility preservation may also require some modification of cancer therapy; thus, patients' wishes regarding future fertility and available fertility preservation alternatives should be discussed before initiation of therapy. This commentary provides an overview of the range of fertility preservation options currently available and under development, using case-based discussions to illustrate ways in which fertility preservation can be incorporated into oncology care. Cases involving breast cancer, testicular cancer, and rectal cancer are described to illustrate fertility issues experienced by male and female patients, as well as to provide examples of strategies for modifying surgical, medical, and radiation therapy to spare fertility. Current guidelines in oncology and reproductive medicine are also reviewed to underscore the importance of communicating fertility preservation options to young patients with cancer.

Figure 1. Navigating the oncofertility treatment path

Questions about a young patient’s desire for future fertility begin with a cancer diagnosis. If a patient is not interested in fertility preservation, cancer therapy can proceed. However, if a patient is interested in attempting to preserve future fertility, the next steps involve both patient counseling and coordination of care. A fertility preservation plan can be tailored to an individual’s circumstances and reflect both established and experimental options. After a treatment plan incorporates both the need to treat a patient’s disease and their wishes regarding future fertility, the final step is initiation of cancer therapy.