Preserving Fertility of Women with Cancer Is Often Neglected

Cancer and infertility can be a double blow. Many women become infertile following cancer treatment. And because more women are living longer thanks to modern chemotherapy and radiation treatment, more are later discovering that they cannot bear children.

Mitchell Rosen

On the bright side, techniques to enable infertile women to bear children -- such as egg cryopreservation -- are improving at a good clip, according to UCSF researchers. Their perspective on the subject appeared online on August 24 in advance of print publication in the journal Nature Reviews: Clinical Oncology. Prognostic tests to help evaluate infertility also have become better. One such test is an ultrasound exam to count egg-bearing follicles in the ovaries. Another is a lab test to measure blood levels of the hormone AMH. These tests may provide a better gauge of a woman’s infertility risk than age or family history alone, according to the UCSF researchers. “Most of us take for granted the ability to have children, but infertility is one of the great quality-of-life concerns for cancer survivors,” says UCSF endocrinologist and fertility expert Mitchell Rosen, MD, senior author of the perspective. “We have an opportunity to preserve fertility.”

Many Women Are Not Informed About Fertility Preservation

Rosen and colleagues earlier conducted a statewide survey to learn about the concerns or regrets of female cancer survivors in their reproductive years, and many women reported a lack of information and communication related to infertility risk and options for reducing the risk. Most childless, young women diagnosed with cancer want to have children one day, according the UCSF authors of the perspective. But despite progress in identifying infertility risk and in treating infertility, at least one-third of women of childbearing age who risk infertility due to radiation or chemotherapy for cancer are never told about the possibility of freezing eggs or other techniques for preserving fertility, the authors report. Rosen has created a multidisciplinary team that includes endocrinologists, a nurse coordinator, a genetic counselor, a psychologist and researchers. “We are dedicated to improving the chance to build a family for patients that have been diagnosed with cancer,” he says. This team works with oncologists at UCSF and throughout the West Coast to help inform patients about infertility risks of cancer treatment and to provide options for preserving fertility. Consultation is available within one to two days of a cancer diagnosis, Rosen says.

Infertility Affects Even Young Cancer Survivors

The Nature Reviews perspective includes an account by an anonymous, young cancer survivor who became infertile as a result of treatment for breast cancer diagnosed when she was 23. “The fertility clinic I first visited after cancer treatment did not specialize in cancer patients,” she writes. “The clinic tried to help the best they could, but in the end, pointed back to the chemotherapy as the source of my infertility. It doesn’t feel quite right that this dream was taken away from me. “I was not given the choice to freeze my eggs and at the time all fertility discussions were dismissed. ‘You are young.’ That seemed to be a recurring theme coming from each doctor I visited.” Rosen notes that the number of eggs contained in the ovaries’ follicles varies markedly between women of similar age. The number decreases gradually with age. Contrary to popular misconception, this number does not “suddenly drop off the end of a cliff,” Rosen says.

Counting follicles using ultrasound of the ovaries aids in gauging infertility risk.

Chemotherapy and radiation appear to affect follicles in a way that accelerates egg loss. Some women appear to be less affected than others. “It is certainly possible that the more eggs a woman has to begin with, the more likely she is to remain fertile despite cancer treatment,” Rosen says. “The Fertility Preservation Program at UCSF individualizes care to help predict who may be more affected by treatment.”

To Preserve Fertility, a Cancer Diagnosis Calls for a Prognosis and a Plan

According to the National Cancer Institute’s Surveillance Epidemiology and End Results database, each year more than 120,000 women under age 50 receive a cancer diagnosis. Oncologists should work more closely with fertility experts to explore the fertility prognosis and options for women of childbearing age with cancer, the UCSF researchers say. “As cancer treatment strategies advance, we must keep an increasingly attentive eye on how we are affecting our patients’ quality of life after cancer treatment. We must work together and plan with foresight, rather than working separately, in hindsight, to mend missed opportunities,” the authors state.

A Changing Perspective: Improving Access to Fertility Preservation

Joseph M. Letourneau, Michelle E. Melisko, Marcelle I. Cedars and Mitchell P. Rosen

Nature Reviews: Clinical Oncology (September, 2010)


Related Links:

UCSF Fertility Preservation Program