A survey on fertility management in young women of reproductive age treated with chemotherapy

Treatment-related infertility is an important issue for cancer survivors of reproductive age. We aimed to determine the understanding and management of fertility issues in cancer survivors by health care providers. We studied 112 patients aged 15-40 years who underwent chemotherapy in Tokushima University Hospital. The gynecologists and oncologists who treated these patients were surveyed regarding their concerns about infertility issues in young cancer survivors. Of the 112 women studied, 57 had iatrogenic amenorrhea. Five were referred to reproductive specialists before or during treatment. Three patients with breast cancer were referred after treatment; they could not undergo fertility treatment due to ovarian failure after chemotherapy. Forty-five medical doctors answered the survey: 21 gynecologists (including 9 fertility specialists), 13 oncologists, and 11 surgeons. Of the oncologists and surgeons, 37.5 % (9/24) referred their patients to fertility experts. They listed certain issues regarding the patients: (1) anxiety that the intervention will alter the prognosis by delaying cancer treatment, and (2) a lack of communication between the oncologist and the fertility specialist. Almost all physicians agreed that fertility counseling was needed before chemotherapy. This report showed the importance of oncofertility counseling and cooperation between oncologists and fertility specialists. Fertility in cancer survivors depends on type of cancer treatment applied, chemotherapy regimen, and age at treatment. Our institute is now equipped for oncofertility counseling and refers patients for fertility preservation prior to cancer treatment.