Discussing fertility with AYAs diagnosed with cancer
Sterility, infertility or subfertility is a significant and distressing consequence of treatment for many young people diagnosed with cancer. There is clear evidence that young people with cancer are concerned about the potential impact of their cancer diagnosis and treatment on their future fertility.
Health professionals working with AYA cancer patients should be aware of the risk to future fertility of cancer treatments and ensure patients are informed of their options for protecting or preserving their fertility before treatment begins.
In some centres, the practice of discussing the risk of infertility with AYAs diagnosed with cancer and referring them for assisted reproductive assessment is routine. However, many young people report feeling that:
- they were not, or were inadequately, advised of the risk or their options for preserving fertility.
- the decision about whether to pursue fertility preservation or not was made for them
- they were not given enough time to discuss concerns
- they did not fully understand the ramifications of the decision.
This section includes advice about discussing fertility with AYAs diagnosed with cancer to maximise their awareness and understanding of their options and optimise future fertility outcomes.
- Multidisciplinary Working Group convened by the British Fertility Society. A strategy for fertility services for survivors of childhood cancer. Hum Fertil (Camb) 2003 May;6(2):A1-A39 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/12869793.
- Lee SJ, Schover LR, Partridge AH, Patrizio P, Wallace WH, Hagerty K, et al. American Society of Clinical Oncology recommendations on fertility preservation in cancer patients. J Clin Oncol 2006 Jun 20;24(18):2917-31 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/16651642.
- Achille MA, Rosberger Z, Robitaille R, Lebel S, Gouin JP, Bultz BD, et al. Facilitators and obstacles to sperm banking in young men receiving gonadotoxic chemotherapy for cancer: the perspective of survivors and health care professionals. Hum Reprod 2006 Dec;21(12):3206-16 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/16887922.
- Crawshaw MA, Glaser AW, Hale JP, Sloper P. Male and female experiences of having fertility matters raised alongside a cancer diagnosis during the teenage and young adult years. Eur J Cancer Care (Engl) 2009 Jul;18(4):381-90 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/19594609.
- Peate M, Meiser B, Hickey M, Friedlander M. The fertility-related concerns, needs and preferences of younger women with breast cancer: a systematic review. Breast Cancer Res Treat 2009 Jul;116(2):215-23 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/19390962.
- Tschudin S, Bitzer J. Psychological aspects of fertility preservation in men and women affected by cancer and other life-threatening diseases. Hum Reprod 2009;Update 15(5):587-59.
- Nagel K, Neal M. Discussions regarding sperm banking with adolescent and young adult males who have cancer. J Pediatr Oncol Nurs 2008;25(2):102-6 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/18270309.
- Edge B, Holmes D, Makin G. Sperm banking in adolescent cancer patients. Arch Dis Child 2006 Feb;91(2):149-52 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/16174641.
- Burns KC, Boudreau C, Panepinto JA. Attitudes regarding fertility preservation in female adolescent cancer patients. J Pediatr Hematol Oncol 2006 Jun;28(6):350-4 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/16794502.
- Anderson RA, Weddell A, Spoudeas HA, Douglas C, Shalet SM, Levitt G, et al. Do doctors discuss fertility issues before they treat young patients with cancer? Hum Reprod 2008 Oct;23(10):2246-51 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/18614615.