Why is early referral important?










Lee, et al1 retrospectively studied the timing of Fertility Preservation (FP) consultation in breast cancer patients.  They found that patients who were referred prior to(rather than after) surgery, were more likely to have:
  • An earlier start of controlled ovarian stimulation (COS) cycle
  • An earlier start of chemotherapy – 24 days earlier (p=0.045)
  • The option for a 2nd stimulation cycle
    • 9/35 women with FP consult before surgery vs. 2/58 with FP consult after surgery 
    • With a 2nd COS cycle, women could freeze more embryos or oocytes
  • Limitations:
    • Retrospective study design
    • More women were ER+ in the post-surgery FP consultation group

What if cancer treatments are starting immediately?





Even in cases where cancer treatments need to start immediately (for example, cases of leukemia), patients may benefit from a referral to a fertility specialist.

  • They may opt for treatments such as GnRH agonists during their chemotherapy.
  • In general, patients prefer more information, rather than less. Even if banking eggs or embryos is not feasible before cancer treatments begin, patients may appreciate having a complete discussion with an expert about risks to future fertility, and options for the future.
  • Often patients with cancers like leukemia do not recieve treatments initially that are especially gonadotoxic. However, if they have a relapse, they may need a bone marrow transplant in the future, and this would require high-risk gonadotoxic treatments. In these cases, early communication with a fertility specialist may allow for fertility preservation treatment options, in appropriate patients.



1. Lee S, Ozkavukcu S, Heytens E, Moy F, Oktay K. Value of early referral to fertility preservation in young women with breast cancer. J Clin Oncol;28:4683-6.

About the Author

Jennifer Mersereau, MD, MSCI, is an reproductive endocrinologist in the University of North Carolina's Department of Obstetrics and Gynecology. As the Director of the Fertility Preservation Program, she has extensive experience guiding patients and physicians through the oncofertility experience.

This page was last updated March 14, 2012.