The Importance of Fertility Preservation in Providing Optimal Cancer Care
Cancer treatment can result in sterility or infertility in several ways, such as after surgical removal of reproductive organs or damage to germ cells from chemotherapy or radiation. As part of informed consent prior to therapy, oncologists should discuss with patients the possibility of infertility — and the options for preserving the ability to have children.
A health care provider may think, “This person is too sick, they won’t live long enough,” says Alice Rhoton-Vlasak, M.D., a professor in the UF department of obstetrics and gynecology’s division of reproductive endocrinology and infertility. But having information about fertility preservation before cancer treatment improves the quality of a patient’s survivorship, she says.
“For example, even if a woman with breast cancer decides not to do anything about fertility, studies have shown that if she becomes a survivor, even if she is sterile, her quality of life will be better if she had information. She knew what to expect, and she knew that even if her own fertility was not preserved, she would have reproductive options.”
Using a teamwork-oriented multidisciplinary approach, physicians in the division of reproductive endocrinology and infertility have created a three-part program: clinical services, research and education. The program has a navigator who handles all inpatient consults. All three components are important to help overcome barriers to fertility preservation.
One barrier is that providers and patients often don’t think about fertility while dealing with a life-threatening diagnosis, and timeliness is vital. The UF Health program offers very quick service. “For example, one day I got a call about a young man with testicular cancer who was scheduled for surgery that day,” Rhoton-Vlasak says. “I saw him one hour later and we banked his sperm. Sperm can be frozen immediately and stored almost indefinitely.”
The UF team can see women very quickly, too. Preserving eggs and even embryos is possible, but freezing eggs takes about 2 weeks, so quick referral is crucial. “There is no faster way, and a woman may not want to delay treatment,” Rhoton-Vlasak explains.
Another barrier is cost. Most states don’t require insurance companies to cover fertility preservation, so most don’t. Whenever possible, UF Health refers patients to charities that can help.
The research component of the program aims to advance the science of preserving reproductive potential. One study is exploring the possibility of freezing ovarian tissue for post-treatment transplantation. The education component targets not just patients but also providers, so they can make referrals. Fertility preservation is available to any male or female patient, even prepubertal, but there are proven options only for postpubertal patients.
Fertility preservation is not limited to cancer patients and should be discussed before treatment of certain autoimmune and genetic diseases. Also, transgender individuals may want to preserve eggs or sperm before making their transition. “This program helps link providers in many different disciplines,” Rhoton-Vlasak says. “It’s a collaborative, team-building program. That’s why it continues to grow."