COSA:AYA cancer fertility preservation/Discussing fertility/Timing
|Guidelines contents||Introduction||Recommendations||Discussing fertility||Management||Impact||Options||Follow-up||Resources|
Discuss fertility early and fully
|All AYAs with cancer requiring treatment that could compromise future fertility must be informed of the likely risk and options to protect or preserve fertility before treatment begins.||B|
|Health professionals should be guided by institutional policies and protocols, if they exist, on when and how to discuss fertility with newly diagnosed patients, how to discuss procedures that may be investigational and/or costly to patients and their families, and how to make referrals to fertility or other specialists.||PP|
Research shows that the majority of young people diagnosed with cancer are concerned about their future fertility regardless of their age or stage of disease. In many cases, fertility preservation is possible.
All patients who require treatment that could compromise future fertility must be given the opportunity to discuss the effects of the treatment and all available options to protect or preserve fertility with their oncologist and/or a fertility specialist. Where appropriate discussion should include partners and families. Referral to a counselor or psychologist with fertility/oncology experience for further discussion may be recommended.
This discussion should take place before the patient begins treatment whenever possible. If patients are not fully informed or properly referred before treatment begins, opportunities may be missed. (See Options for fertility preservation for further discussion about best timing for preservation processes). There may also be medicolegal implications of not clearly advising patients and family of fertility preservation options (and recording it).
The oncologist and/or fertility specialist should ensure patients are informed about:
- the acute and long term effects of the cancer treatments on their fertility
- the available fertility preservation opportunities, including investigational techniques if appropriate for the patient
- the impact of fertility preservation treatments on the patient’s cancer treatment, any potential damage to their oocytes or sperm and any risks to future offspring 
- the acceptability, and also the potential implications of choosing not to take fertility measures
- if appropriate to the patient, the need for contraception and potential changes to sexuality
- if relevant and possible, potential moral, ethical and legal issues, such as ownership of embryos or reproductive tissue in the event of a patient’s death or incapacity.
Patients who do not receive comprehensible or adequate information have been shown to have a worse quality of life up to four years after their diagnosis.