Fertility Options for Female Cancer Patients

Receiving the diagnosis of cancer for a young woman can be a
devastating experience. Immediately, a deluge of urgent decisions
arise for both the patient and her treating physicians. Is surgery
necessary? How about chemotherapy or radiation? With all of the
immediate decisions that need to be made, all of the office visits,
imaging studies and blood tests that are routinely performed,
essential questions about the potential impact of cancer therapy on
the future health and quality of life of the young woman are
unfortunately frequently overlooked.Hopefully, the woman receiving the
diagnosis finds her way into the care of an oncologist (cancer
specialist) and that oncologist is prepared to discuss all of the
options regarding treatment as well as potential side effects of that
treatment- including the impact it may have on a woman's future
fertility. In order of decreasing frequency, the most common cancer
diagnoses for women under the age of 40 include: breast cancer,
melanoma, cervical cancer, leukemia, Non-Hodgkin's lymphoma, and
uterine cancer. Particularly if discovered in their early stages,
these cancers are associated with good treatment response and survival
statistics. However, the necessary treatment options required to cure
many of these malignancies involve therapies that have a significant
impact on fertility.Surgery that removes the ovaries, uterus or cervix
obviously leads to fertility challenges. However, it is essential that
the treating surgeon discuss options for fertility-sparing surgical
procedures. A woman should be appropriately counseled as to whether or
not her particular cancer might be treated with one of these
fertility-sparing options, and how (if at all) this might impact her
chance of relapse or recurrence. True informed consent means that all
of the options have been presented, risks and benefits have been
thoroughly reviewed, and all of a woman's questions have been
addressed. The impact of systemic chemotherapy for the treatment of
cancer is often under appreciated. Many of the most commonly used
chemotherapy agents can lead to a condition called
chemotherapy-related ovarian failure. The risk of ovarian failure
after chemo depends on the patient's age (older women have a higher
risk of failure), the specific agents used (alkylating agents can be
particularly adverse), and the total dose administered (more cycles
lead to a higher risk of long-term impact).Radiation can also affect
future fertility, again varying dependent on the patient's age, the
location of the irradiated field, and the total dose received. Simple
surgical procedures such as lifting the ovaries out of the field of
radiation (known as oophoropexy), can have significantly beneficial
impact on the rate of radiation-induced ovarian failure. Even if the
cancer itself cannot be treated surgically, women should be informed
of the option of oophoropexy and referred to a gynecologic oncologist
who can perform this procedure.Embryo, oocyte and ovarian tissue
cryopreservation as well as the use on GnRH-analogue treatment
concurrent with chemotherapy or radiation are options for young women
undergoing treatment for cancer. A referral should be made to a
reproductive endocrinologist who will be able to fully address their
respective risks, benefits, outcome measures, and appropriateness for
each woman considering future fertility.An interdisciplinary and often
integrative approach, with excellent communication between a woman and
her various subspecialists is essential to successfully address all of
these questions and concerns. As frightening as a cancer diagnosis may
be, young women deserve the careful and thorough review of all of the
options available to them, with special consideration made to their
ability to retain fertility if they so desire. There can and must be
hope on the horizon for young women with cancer.