COSA:AYA cancer fertility preservation/Long term follow up/Psychosocial impact

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Fertility preservation for AYAs diagnosed with cancer: Guidance for health professionals. > COSA:AYA cancer fertility preservation/Long term follow up/Psychosocial impact

Psychosocial impact of infertility and sexual health issues

Recommendation Grade
The potential psychological and psychosocial impact on AYA cancer survivors of undertaking, or not undertaking, fertility prevention measures should be regularly assessed. Survivors should be offered fertility counselling and psychological support.

Cancer survivors who have reproductive problems may experience substantial anxiety, which negatively affects their quality of life.[1]

Survivors who are infertile as a consequence of their treatment are at increased risk of emotional distress.[2][3] Patients may also experience regret and a feeling of injustice if they believe their fertility may have been unnecessarily sacrificed due to a lack of information about preservation options.[4][1][5][3]

Early referral for counseling is beneficial to prevent or reduce significant emotional and relationship problems in the future.

As patients progress through and beyond their cancer treatment their questions and feelings regarding their fertility change, depending on their life stage.[6][7][2][5][8][9] It is therefore essential that health care professionals and patients continue to discuss issues of fertility and reproductive and sexual health in order to meet the changing needs of a patient.

Many patients who may be able to conceive face a moral dilemma and a fear of passing on their cancer to their offspring,[8] while some perceive it as selfish to have children when their life span is potentially limited.[2][5] For a substantial proportion of women, the potential of premature menopause or shortened fertility is an additional emotional stress that can impact on life decisions.[5]

Discussing these issues with a potential future partner may be very difficult. AYA cancer survivors are forced to consider when and how to explain that they can’t or may not be able to have children. Some young people may avoid relationships as a result, which may explain the lower marriage/adult partnerships rates and parenthood rates seen in this population.

Sexuality is of increased importance to AYAs and changes due to cancer can affect their body and self image, potentially impacting on future relationships. Male patients may feel fear, anger or sadness with a change to their sexuality.[10] For some young women, the use of hormonal contraception can create further anxiety.

  • As part of ongoing monitoring of survivors’ reproductive and sexual health, health professionals should provide information about fertility options, sexuality, contraception, breast feeding, relationships and inheritable cancers and refer patients to counselling or support as required.

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  1. 1.0 1.1 Garner E, Goldstein DP, Berkowitz RS, Wenzel L. Psychosocial and reproductive outcomes of gestational trophoblastic diseases. Best Pract Res Clin Obstet Gynaecol 2003 Dec;17(6):959-68 Abstract available at
  2. 2.0 2.1 2.2 Oosterhuis BE, Goodwin T, Kiernan M, Hudson MM, Dahl GV. Concerns about infertility risks among pediatric oncology patients and their parents. Pediatr Blood Cancer 2008 Jan;50(1):85-9 Abstract available at
  3. 3.0 3.1 Rosen A, Rodriguez-Wallberg KA, Rosenzweig L. Psychosocial distress in young cancer survivors. Semin Oncol Nurs 2009 Nov;25(4):268-77 Abstract available at
  4. Carpentier MY, Fortenberry JD. Romantic and sexual relationships, body image, and fertility in adolescent and young adult testicular cancer survivors: a review of the literature. J Adolesc Health 2010 Aug;47(2):115-25 Abstract available at
  5. 5.0 5.1 5.2 5.3 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
  6. Royal College of Physicians, The Royal College of Radiologists, Royal College of Obstetricians and Gynaecologists. The effects of cancer treatment on reproductive functions: Guidance on management. Report of a Working Party. 2007;London: RCP; Accessed March 2011. Abstract available at
  7. Schover LR. Reproductive complications and sexual dysfunction in cancer survivors. In: Ganz PA, editor. Cancer survivorship: today and tomorrow. New York: Springer; 2007.
  8. 8.0 8.1 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.
  9. 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
  10. Madanat LM, Malila N, Dyba T, Hakulinen T, Sankila R, Boice JD Jr, et al. Probability of parenthood after early onset cancer: a population-based study. Int J Cancer 2008 Dec 15;123(12):2891-8 Abstract available at

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