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Retaining Fertility in Oncology Patients

According to the American Cancer Society (ACS), over a million new cancer cases will be diagnosed in 2013. Of those, 8 percent of patients will be under the age of 45. Furthermore, the ACS specifies that 1.1 percent of those patients will be under the age of 20. As technology advances have allowed for more effective treatments, those cancer patients can now consider life options during remission, including raising a family.

Dr. Robert J. Homm, of Fertility and Endocrine Associates in Louisville, Kentucky, has been a practicing reproductive endocrinologist for 21 years. Fertility and Endocrine Associates has been treating men for the last 15 years using sperm cryopreservation. Female patients can choose between oocyte cryopreservation and embryo cryopreservation, the latter procedure in use since 2006. Dr. Homm says that there are very clear guidelines about treatment and counseling as provided by the American Cancer Society. While several other types of fertility treatments, such as testicular tissue preservation, are still considered experimental, overall “there are better standards of care, since Institutional Review Board (IRB) protocol ensures experimental procedures.”

It is necessary to note that fertility issues are often the result of the treatment that the cancer patient undergoes. In a 2013 article titled “Fertility Issues in Cancer Survivorship” published by the American Cancer Society, the authors note that for female cancer patients, radiotherapy may be detrimental to future fertility, while chemotherapy results vary from patient to patient. The use of biologicals and their subsequent effects on fertility has not been thoroughly tested; as such, there is limited data to make fertility recommendations.

Another recent article titled “Fertility Outcome of Patients with Testicular Tumor” notes that sperm cryopreservation or sperm banking is the most effective fertility treatment for men and is not typically associated with birth defects or malignancies. However, there are several considerations that may be addressed during a consultation. For instance, there are a small percentage of men whose sperm are unable to survive the freezing process.

In general, while health-care providers may feel uncomfortable bringing up the subject of fertility at the time of a cancer diagnosis, there must be some discussion of plans after cancer, given that treatment-related infertility is strongly associated with depressive symptoms and can hinder a cancer survivor’s quality of life.

Dr. Homm stresses that it is important for physicians to get their patients to a reproductive specialist as soon as possible, saying, “With some of the younger patients, they might be in shock, but there is an aggressive timeline.” In his previous experience, as many as 25 percent of patients he treats have not been given access to such counseling. Counseling is necessary to determine the best course of action for a patient should he or she decide to pursue pregnancy or child-rearing later on. Otherwise, patients may run the risk of spending money trying an experimental procedure, only to discover that the procedure has failed and that the treatments have rendered them infertile.

In the end, Dr. Homm notes that the best thing a physician can do for his or her patient is: “Try to always be optimistic.”

By Lydia Cheng

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