Fertility Help Not Equal for Cancer Patients

Not all young women receiving fertility-threatening cancer treatments have had equal access to counseling or preservation services, researchers found.

Patients with a college degree were more likely than women from other backgrounds to receive fertility services before treatment, Joseph M. Letourneau, MD, of the University of California at San Francisco School of Medicine, and colleagues reported.

However, despite improvements to fertility preservation awareness over the last 10 years, female cancer patients of less educated, minority, or nonheterosexual backgrounds showed a tendency toward an unmet need for fertility preservation services, the researchers wrote in the journal Cancer.

Surgery, chemotherapy, and/or radiation therapy can bring on premature menopause in young women. Consequently, the American Society of Clinical Oncology has recommended that patients of childbearing age should be offered counseling on options such as egg or embryo preservation that will allow them to have children later on if the wish.

Letourneau and colleagues contacted about 2,500 women who had been diagnosed with cancer from 1993 to 2007. They had responses from 1,041, including 918 whose treatment could compromise fertility and who were included in the analysis.

Note that in a retrospective study of women diagnosed with cancer between the ages of 18 and 40 years and treated with modalities with potential to affect fertility, women who had not attained a bachelor's degree were less likely to be counseled about fertility preservation.

Note that counseling on and use of preservation services appeared to increase over time, although, as recently as 2007, nearly 40% of patients were not offered such counseling.

The survey asked whether counseling about the risk of cancer treatment to fertility had been offered by a healthcare professional prior to treatment, and whether the patient pursued fertility preservation services under the care of a reproductive endocrinologist.

Cancer treatment and fertility-preserving options

Discussions about how to attempt to preserve your fertility need to happen before cancer treatment. Age, gender, physical and sexual maturation, and, in some cases, relationship status (for example, whether a woman currently has a partner) affect the options available for fertility preservation. Your doctor and/or a reproductive endocrinologist (a doctor who specializes in fertility issues) can help you learn about your options.

Unfortunately, not all options are available or appropriate for everyone. Fertility-preserving procedures may be stressful during an already difficult time, and they are not always effective. Many options, including in vitro fertilization (a process that involves collecting a woman’s eggs and fertilizing them with sperm outside her body, then transferring the embryo back into her body for it to develop) and embryo cryopreservation (freezing fertilized eggs for later reimplantation), may be costly. In addition, some people may face ethical questions about various options, so it is important to talk with your doctor to find the information you need to make the best decision. You may also consider speaking with a counselor for guidance about these decisions.