Preservation of fertility in adults and children diagnosed with cancer

doi:10.1136/bmj.a2045

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Roger Hart, associate professor of reproductive medicine1, medical director2

¹School of Women’s and Infants’ Health, University of Western Australia, Perth, WA 6008, Australia
²Fertility Specialists of Western Australia, Perth, WA 6010

roger.hart{at}uwa.edu.au

Accepted 24 September 2008

Summary points

Warn patients of the possible effects that treatment may have on their reproductive capacity
Provide access to a fertility specialist and supportive counselling
Sperm banking is an effective and well established technique for adolescent boys and men
Women should be offered access to oocyte or embryo freezing if sufficient time is available before treatment begins
Oocyte cryostorage has limited success and freezing of ovarian tissue is still experimental

In the United Kingdom each year 11 000 patients aged 15-40 years are diagnosed with cancer, and more than half of them will live for more than five years.1 2 Patients want quality of life, including the ability to have a family, and many request advice on fertility preservation. This review describes the fertility preservation techniques available and recent recommendations from the UK and the United States.3 4 5

Sources and selection criteria

We searched Medline and the Cochrane library using the keywords “cancer and fertility”, “chemotherapy and fertility and radiotherapy and fertility”, “fertility preservation”, “ovarian transposition”, “oocyte freezing/cryopreservation”, “sperm freezing/cryopreservation”. We also used information from the National Institute for Health and Clinical Excellence; the Royal College of Physicians, Royal College of Radiologists, and Royal College of Obstetricians and Gynaecologists working party; and the American Society of Clinical Oncology.

Why should oncology patients consider fertility preservation?

Chemotherapy and radiotherapy reduce the number of germ cells within the ovary and decrease testicular spermatogenesis; this reduction is related to the dose, agent used, and age at treatment. In addition, patients are at risk of permanent gonadal failure.3 4 The persistence of menstrual cycles after treatment does not preclude ovarian damage, and the preservation of testosterone production does not confirm the preservation of spermatogenesis.

Who should be referred to discuss fertility preservation options?

UK and American Society of Clinical Oncology (ASCO) guidelines recommend that the implications of oncological treatment for fertility are discussed with patients.3 5 The need to refer for fertility …