Re: Preserving fertility in girls and young women with cancer
Dear Editor of BMJ,
We read with interest the BMJ editorial “Preserving fertility in girls and young women with cancer” BMJ 2016;355:i6145.
We agree with Anderson et al that provision of fertility preservation is particularly haphazard across the UK and that there are substantial obstacles in terms of access and funding. We have recently carried out a UK wide survey to examine the provision of oocyte and/or embryo cryopreservation for female oncology patients prior to cancer treatments, the paper was accepted for publication in Human Fertility and it is currently in press. We found that the number of cases receiving this treatment is remarkably suboptimal.
We cannot agree with the authors, however, that we do not know how many women are undergoing fertility preservation since “UK data collection does not include the reason for oocyte cryopreservation”. HFEA data showed that only 154 cases of NHS funded oocyte cryopreservation were carried out in 2014.
With 8122 women in the UK between the ages of 15-39 annually diagnosed with a malignant form of cancer in between 2011-2013, (CancerResearchUK, 2011 - 2013), it is suggested that approximately half (4000) would receive oncology treatment that could affect their future fertility (Oktay & Sonmezer, 2008) and hence should be referred for timely fertility preservation consultation. Our survey data collected from individual centres in the UK suggest that approximately half of the women seen for a fertility preservation consultation proceed to embryo or oocyte cryopreservation, hence we would expect approximately 2000 cycles of embryo and oocyte cryopreservation to be undertaken annually. The 154 cases of NHS funded oocyte cryopreservation represent as little as 7.5% of this target number.
Whilst we do recognise that social oocyte cryopreservation may increase the overall number of oocyte cryopreservation, we believe this effect is not seen in the NHS funded oocyte cryopreservation, since the NHS categorically doesn’t fund social egg freezing. Therefore the 154 cases are likely to be mostly related to fertility preservation.
We also recognise that there is additional fertility preservation carried out in the form of embryo cryopreservation, However, as the authors also explain, embryo cryopreservation before cancer treatment has become a secondary option to oocyte cryopreservation after the advent of vitrification technology, whilst at the same time oocyte cryopreservation has the advantage over embryo storage of offering women more independence and autonomy over their fertility. Therefore, while it can be assumed that almost all 154 cases of NHS-funded oocyte cryopreservation are almost all cancer related, the same does not apply in embryo cryopreservation cases as the majority of the latter are carried out during the course of ordinary assisted conception treatment.
Additionally, we do recognise that there is also an additional small number of privately funded oocyte cryopreservation for fertility preservation. Our data looked at the funding of oocyte cryopreservation provided both by NHS and privately. Our data showed that the percentage of women whose cryopreservation prior to cancer treatment was NHS funded is estimated to be 65% to 76%. This may suggest that the overall fertility preservation is approximately 10% of the overall target at best estimate.
Given this low rate of fertility preservation provision, we agree with Anderson et al that improvements can be made in the number of referrals from oncology, the provision of cryopreservation treatment and of NHS funding provision. Developing a national fertility preservation network and close liaison with oncology and Clinical Commissioning Groups are recommended.
Yazan Abdallah (1), Jonathan Briggs (2), Cheryl T Fitzgerald (1)
1. Department of Reproductive Medicine, Saint Mary’s Hospital, Oxford Road, Manchester, M13 9WL UK
2. School of Medicine, University of Manchester, Oxford Road, Manchester, M13 9PT, UK
CancerResearchUK. (2011 - 2013). Cancer Research UK, http://www.cancerresearchuk.org/health-professional/cancer-statistics/in... http://www.cancerresearchuk.org/health-professional/cancer-statistics/in....
HFEA. (2016). Fertility Treatment in 2014: Trends and Figures.
Oktay, K., & Sonmezer, M. (2008). Chemotherapy and amenorrhea: risks and treatment options. Curr Opin Obstet Gynecol, 20(4), 408-415. doi:10.1097/GCO.0b013e328307ebad
Competing interests: No competing interests