Women get less information on post-cancer fertility: study
Cancer treatment can sometimes lead to infertility, but young women are far less likely than young men to be informed of this, according to a Swedish study.
Findings published in the Journal of Clinical Oncology found that of nearly 500 cancer survivors aged 18 to 45, 80 percent of men surveyed said their doctor had told them their chemotherapy could affect their future fertility.
But only 48 percent of women said the same. In addition, only 14 percent of women said they received information on options to preserve their fertility, versus 68 percent of men.
The gap is likely related to the fact that preserving fertility is more complicated in women than men and techniques for doing so are not as widely available, said the researchers.
“Even in cases when fertility preservation could not be performed, patients - and in particular, women - should be informed about their risk of decreased fertility and their risk of entering menopause prematurely,” senior researcher Claudia Lampic, of the Karolinska Institute in Stockholm, told Reuters Health in an email.
Some chemotherapy drugs can damage a woman’s eggs or a man’s ability to produce normal sperm. Radiation therapy near the reproductive organs, or to the brain, can harm fertility, as can hormonal therapies for breast, prostate and other cancers.
Many women of childbearing age who have been diagnosed with cancer think that preserving their fertility is important and want information about their options. However,
- Patients may not feel comfortable bringing up fertility issues.
- Patients may not be aware of their options for preserving fertility.
- Patients may be focused on their cancer diagnosis and unable to think about fertility or the possibility of having a future family.
- Women may later regret not considering fertility issues prior to starting cancer treatment.
Understanding that there are fertility preservation options available and referring at-risk patients to specialists can improve patients’ emotional outlook and future quality of life.
Even women with a poor prognosis may want to consider fertility preservation.
A recent U.S. survey of women diagnosed with cancer when they were 40 or younger found that more than half said they still wanted to have children at the time of their diagnosis.
“The options are out there, but the utility is still patchwork right now,” Oktay said.
Men can have their sperm frozen and banked before cancer treatment, a relatively quick and simple process that is also comparatively inexpensive.
Starting the Conversation
You may not be comfortable speaking with your patients about the risk of infertility related to their cancer or planned cancer treatment. These key points can help start the conversation:
- Cancer and cancer treatment may affect your fertility.
- Based on your treatment plan, your risk of infertility is [high, moderate, low].
- Have you ever thought about having a child/more children? Although it may not be on your mind now, many patients find themselves wishing they had thought about this when they had the chance.
- You have options to try to preserve your fertility before you begin cancer treatment.
- Cancer, cancer treatment, or fertility preservation will not harm your future children. (Although you may pass on the gene for some hereditary cancers, we may be able to test for those).
- You may retain or regain your fertility, or not make use of any fertility preservation methods you may have used. However, it is important to explore your options now to avoid regret in the future.
- Fertility preservation and pregnancy do not appear to increase the risk of cancer recurrence; however, pregnancy may be considered high risk.
- I can refer you to a fertility preservation specialist if you would like to discuss your options further.
- Remember that there are other ways to build a family after cancer if we are unable to preserve your fertility now. Talking with a specialist can help you explore other options that might be right for you.
For women, the most common way is to have in vitro fertilization to create embryos, which are then frozen and banked. It’s also possible to freeze a woman’s eggs and ovarian tissue, but that’s still considered experimental and it’s not clear how well they work - and they are all more expensive.
What is infertility?
Fertility is a person’s ability to start or maintain a pregnancy. Infertility is not being able to start or maintain a pregnancy. For a woman, it means that she either can’t become pregnant or that she can’t carry a baby full-term. For a man, it means that he cannot father a child. In medicine, it is defined for couples as being unable to conceive a child after one year of trying to get pregnant.
Men are infertile if:
- Their testicles do not make sperm.
- The pathways that carry sperm are blocked or cut off.
Women are infertile if:
- Their ovaries do not make mature eggs.
- Damage to the reproductive system keeps eggs from being fertilized.
- A fertilized egg cannot implant and grow inside the uterus.
In addition, harvesting eggs generally means using hormonal treatments to stimulate the ovaries. But that raises a woman’s estrogen levels, so women with breast or uterine cancer have not been offered those options.
SOURCE: http://url.health.am/821/
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Sex Differences in Fertility-Related Information Received by Young Adult Cancer Survivors
Results The majority of male participants reported having received information about treatment impact on fertility (80%) and FP (68%), and more than half of the men banked frozen sperm (54%). Among women, less than half (48%) reported that they received information about treatment impact on fertility, and 14% reported that they received information about FP. Only seven women (2%) underwent FP. Predictors for receiving information about treatment impact on fertility were a pretreatment desire to have children (odds ratio [OR], 3.5), male sex (OR, 3.2), and being ≤ 35 years of age at diagnosis (OR, 2.0). Predictors for receiving information about FP included male sex (OR, 14.4), age ≤ 35 at diagnosis (OR, 5.1), and having no children at diagnosis (OR, 2.5).
Conclusion Our results show marked sex differences regarding the receipt of fertility-related information and use of FP. There is an urgent need to develop fertility-related information adapted to female patients with cancer to improve their opportunities to participate in informed decisions regarding their treatment and future reproductive ability.
Gabriela M. Armuand,
Kenny A. Rodriguez-Wallberg,
Lena Wettergren,
Johan Ahlgren,
Gunilla Enblad,
Martin Höglund and
Claudia Lampic