Cancer & Fertility Advisor, LIVESTRONG
Patient Representative, ASRM Fertility Preservation Special Interest Group
Last month, fertility specialists from around the country gathered in Boston for the American Society for Reproductive Medicine?s (ASRM) annual meeting. This conference is the premiere event for professionals in the field of reproductive medicine, bringing together physicians, nurses, mental health providers, scientists, patient advocates and industry representatives every year. Learn more about the conference and about ASRM at www.asrm.org.
Over the past few years, the meeting has increasingly covered topics relevant to cancer survivors such as advances in fertility preservation and research on the effects of cancer treatment on reproductive function. In addition, the Fertility Preservation Special Interest Group (FPSIG) ensures the inclusion of the topic each year and provides a forum within the meeting for dedicated individuals to exchange ideas and discuss emerging developments. The expanding number of live presentations, roundtables, abstracts and posters addressing cancer-related fertility topics reflects the growth of this subspecialty and the interest of the reproductive community in serving cancer patients? fertility needs.
Research on several subjects relevant to cancer survivors was presented at the conference, including:
- Existing gaps in fertility preservation (FP) counseling.
Unfortunately, several studies showed that reproductive-age cancer patients are still receiving FP counseling at low rates (1,2). One survey based on the California Cancer Registry showed GYN patients received sub-optimal FP counseling (3), while a survey based on the Georgia Cancer Registry found more than half of reproductive-aged survivors had had no discussion of fertility (2). Factors shown to reduce the likelihood of discussion in the Georgia survey were young age (20-24) at diagnosis, prior child(ren) or African American ethnicity.
- The value of early fertility preservation (FP) counseling.
Where counseling occurred, patient satisfaction was increased and distress levels were reduced (1,4), particularly when the fertility information came from an oncologist (4). In addition, one study showed the practical value of early fertility counseling for breast cancer patients ? it allowed them time for two rounds of egg collection without delaying the start of their cancer treatment (5).
- Unexplained sub-fertility in patients and survivors.
Studies showed that some cancer patients and BRCA carriers may have a lower than normal ovarian reserve (as shown by hormone tests) even before they undergo cancer treatment (6,7). Another study found that when survivors underwent IVF to become pregnant after treatment, they had lower embryo implantation and pregnancy rates than age-matched controls, even though they had comparable numbers of eggs gathered and frozen for fertility preservation (8). However, better pregnancy results were achieved if they had a higher number of eggs preserved or if they had used a gestational carrier.
A greater understanding of these research outcomes should affect how and when oncology providers address fertility preservation with their patients. When considered together, a theme emerges ? the ongoing need for consistent, early, individualized reproductive fertility counseling. This would allow patients to preserve their fertility without delaying their cancer treatment and would reduce their distress. To find out more about how LIVESTRONG helps patients and survivors with their fertility concerns, go to http://www.LIVESTRONG.org/fertility.
Citations above reflect the abstracts of the oral (O) and poster (P) presentations at the ASRM Conference 2013.
- Reproductive Health Counseling at the time of Cancer Diagnosis Reduces Patients? Fears Regarding Future Fertility. Rosen, et al. (O-75)
- What determines whether women diagnosed with cancer talk with a doctor about the possible effects of treatment on their fertility: An analysis from the Fuchsia women?s study. Spencer, et al. (P-69)
- Women with gynecologic cancers are suboptimally counseled about post-treatment reproductive health outcomes. Rosen et al. (O-212)
- Oncologist-initiated fertility discussion was associated with higher patient satisfaction and better fertility knowledge in young women with cancer. Yee, et al. (P-53)
- Safety and feasibility of performing two consecutive letrozole-fsh stimulation cycles for fertility preservation in women with breast cancer. Oktay, et al. (O-214)
- Before chemotherapy, cancer patients have lower serum AMH than age-matched healthy controls. Eapen (P-1285)
- Risk of Diminished Ovarian Reserve in BRCA 1/2 mutation carriers. Karlan (O-211)