Fertility concerns should be addressed with all newly diagnosed reproductive age cancer patients before their treatment begins. Although some treatment courses are thought to be more damaging to fertility than others, it is imperative that every patient is well-versed about the potential impact their treatment may have on their reproductive future in order to make informed decisions regarding fertility preserving procedures. In a new article in the Journal of Assisted Reproduction and Genetics, entitled, “Recommendations for Fertility Preservation in Patients with Lymphoma, Leukemia, and Breast Cancer,” the authors, ISFP Practice Committee, Kim SS, Donnez J, Barri P, Pellicer A, Patrizio P, Rosenwaks Z, Nagy P, Falcone T, Andersen C, Hovatta O, Wallace H, Meirow D, Gook D, Kim SH, Tzeng CR, Suzuki S, Ishizuka B, Dolmans MM, discuss different types of cancer and their treatment and the corresponding affect on fertility arguing for the importance of standardized fertility preservation counseling prior to treatment.
In “Recommendations for Fertility Preservation in Patients with Lymphoma, Leukemia, and Breast Cancer,” the authors discuss specific types of cancer (luekemia, lymphoma & breast cancer) incident and survival rates, as well as effects on gonadal function. For newly diagnosed breast cancer patients, factors affecting gonadotoxicity are age of the patient, and dose and number of cycles of some types of chemotherapeutics, called alkylating agents. The authors further clarify that many studies measure future fertility risk based on the likelyhood of amenorrhea, which can vary greatly depending on the types of chemotherapy.
In many cases, young breast cancer patients require additional cancer treatment given after the primary treatment, such as chemotherapy after surgery (mastectomy or lumpectomy), to lower the risk that the cancer will come back. The best time for fertility preservation is after surgery and before subsequent chemotherapy or radiation treatment begins. Egg or embryo banking is often recommended as a fertility preservation option for women before chemotherapy. Cryopreservation of embryos or oocytes requires hormonal stimulation which increases the levels of hormones, such as estrogen, in a woman’s body. For women with breast cancer, especially estrogen receptor positive types, this may cause proliferation of the cancer cells and the authors state that these risks should be discussed before the treatment. In addition, they state that women who require urgent cancer treatment, cryopreservation of ovarian tissue should be considered.
All patients who desire to preserve fertility should be counseled and informed about currently available fertility preservation options by their healthcare team. Recommendations should be individualized to the patient dependent on their diagnosis and treatment plan. The authors of “Recommendations for Fertility Preservation in Patients with Lymphoma, Leukemia, and Breast Cancer” state that, in general, fertility preservation before cancer treatment is strongly recommended if the chance of losing fertility is over 30 % with cancer therapy. Patients or clinicians interested in learning more about fertility preservation for a particular case can call the Oncofertility Consoritum’s FERTline for tailored information.