Young cancer patients, often left infertile after treatment, may be unaware of ways to preserve their options for having children, a study suggests.
Out of 459 adolescents and young adults diagnosed with cancer in 2007 or 2008, more than 70 percent said doctors had explained their risk of infertility. But less than 33 percent of men and less than 10 percent of women said they made arrangements for fertility preservation.
Patients who already had children were also less likely to explore fertility preservation than those who didn’t have children, the study found.
Some patients may have thought fertility preservation would delay treatment. Women, for example, might have to wait for the right time in their menstrual cycle to harvest their eggs, said lead study author Dr. Margarett Shnorhavorian, a researcher and pediatric urologist at Seattle Children's Hospital and Research Institute.
“All patients – not just those without children – should have discussions about fertility preservation,” she said by email.
While fertility care continues to evolve, the standard options for teens and young adults are sperm banking for men and egg or embryo banking for women. Younger children have fewer options because they don’t produce sperm or eggs before puberty, but sometimes the testicles or ovaries can be shielded during radiation.
To see how well cancer patients understood their fertility options, Shnorhavorian and colleagues had them answer detailed questionnaires.
Most participants were white, male, and covered by private health insurance. Most were at least 21 when their cancer was diagnosed and were not raising young children of their own.
Eighty percent of men were told they might become infertile, 71 percent discussed options to address the problem, and 31 percent made preservation arrangements.
Nonwhite men were less likely to discuss their options, as were participants who lacked insurance and those who already had children.
Seventy-four percent of women said they were advised that therapy could affect their fertility, but only 34 percent had discussed preservation options. And just 6.8 percent made arrangements to preserve their fertility.
Among the women who explained why they didn’t pursue this option, many cited a lack of awareness or access to affordable options, while 38 percent raised concerns that this might delay treatment.
The relatively small size of the study made it impossible to draw broader conclusions about women who did make fertility preservation arrangements, the researchers acknowledge in the journal Cancer.
The study was done soon after the American Society of Clinical Oncology (ASCO) recommended in 2006 that oncologists discuss infertility risks with reproductive-age patients, the researchers note.
“There is absolutely greater awareness today,” said Dr. Kutluk Oktay, the senior author of the ASCO guidelines and the founder and director of the Innovation Institute for Fertility Preservation in New York.
It’s not surprising that young cancer patients and their parents may be reluctant to raise questions about fertility, Oktay said by email.
They “are under so much psychological and financial pressure that they naturally try to avoid opening up a new front,” Oktay said.
Doctors need to bring up fertility issues, rather than waiting to be asked, he added.
Advances in egg freezing and other fertility options for women may also help narrow the gender gap seen in the study, noted Dr. Jani Jensen, co-director of the in vitro fertilization program at the Mayo Clinic in Rochester, Minnesota.
Because eggs need to mature before they can be collected and frozen, the process for women typically takes 10 to 14 days, compared with a single day for men, said Jensen, who wasn't involved in the study.
"It's not surprising, but it is disappointing, that many patients who could benefit from fertility preservation aren't hearing the message," she said.
"Fertility and childbearing become hugely important for many patients during survivorship," Jensen added.