Counseling cancer patients on their fertility options can be a complicated process. Clinicians caring for cancer patients bear the responsibility for making sure that their patients are well-informed and understand all of their options. As treatment regimes evolve, determining whether or not an individual’s fertility will be compromised can be difficult. For those that elect to have fertility preservation, their options are specific to not only their treatment plan, but also the type of cancer they have, their age at the time cancer treatment begins and ends, pre-existing fertility, etc… There are also risks involved with the procedures required to acquire reproductive tissue as well as with IVF medications. Collaborative work and research as modeled by the Oncofertility Consortium, will help in establishing a set of guidelines specific to oncofertility patients that clinicians can use to help counsel them on their options.
Effectively treating the cancer is an oncologist’s first priority, but ideally they also initiate the conversation about fertility preservation with patients as well. Since current data in the field is often incomplete or limited, clinicians need to be careful not to solely rely upon that for their counseling sessions. It’s important for clinicians to offer patients options for further discussion with someone who has expertise in reproductive medicine and assisted reproductive technologies (ART). Collaboration between the oncologists and the reproductive medicine specialists is the best way to make sure that a patient is receiving consistent information for their specific case and that they are being treated in a timely manner. This collaboration also makes the entire medical team accountable to the patient’s treatment, both for cancer and fertility preservation.
In order to successfully ensure that a patient has been properly educated on all of their fertility preservation options, including all of the risks and the “unknown’s,” it’s recommended to implement a process for obtaining informed consent from an oncofertility patient. One way to do this is by following the American Society for Reproductive Medicine’s (ASRM) practice committee guidelines for counseling and consenting patients in regard to fertility preservation. ASRM guidelines address experimental therapies, considerations for posthumous reproductive decisions, relationship changes (divorce), safety precautions and variety of other issues that are relevant to fertility preservation in oncofertility patients. Referring to existing guidelines is helpful in achieving consistency; however, as the field of oncofertility evolves collaborative work and research is needed to answer the remaining questions associated with fertility preservation and cancer.
To learn more about counseling and consenting oncofertility patients, please read, “Counseling and Consenting Women with Cancer on their Oncofertility Options: A Clinical Perspective," by Emily S. Jungheim PhD, Kenneth Carson PhD, and Douglas Brown PhD in Oncofertility: Ethical, Legal, Social, and Medical Perspectives.