Cancer-Related Infertility in Survivorship

Introduction: To empirically assess and describe the emotional, sexual, and physical impact of cancer-related infertility on gynecologic cancer survivors. Methods: The study was composed of 88 survivors of cervical, endometrial/uterine, ovarian cancer, and gestational trophoblastic disease who experienced impaired or loss of fertility as a result of treatment. Patient age ranged from 21 to 49 years. Participants completed a 1-time self-report survey, including medical and demographic information and empirical measures of mood (Center for Epidemiologic Studies Depression Scale), distress (Impact of Event Scale), sexual function (Female Sexual Function Index), and menopause (Menopausal Symptom Checklist). Results: Eighty-four (96%) of the 88 enrolled patients had undergone a surgical intervention as part of their cancer treatment. Sixty-three patients (77%) reported clinically significant levels of distress in relation to loss of fertility or impaired fertility. Survivors' levels of distress (P < 0.0001) and depression (P G 0.0001) were associated with the severity and number of menopausal symptoms reported. Patients who retained functioning ovaries (partial fertility) (41%, n = 36) reported being less bothered by menopausal symptoms (P = 0.01) and having higher sexual functioning than those with ovarian failure (P G 0.0001). Conclusions: The emotional and physical impact of impaired or loss of fertility can be complex and long lasting, with women experiencing high levels of distress, menopausal symptoms, and changes in sexual function persisting into survivorship. Future research should focus on the development of strategies to identify, monitor, and address, in a clinical care setting, the issues these cancer survivors face. Alternate family-building strategies should also be explored before treatment and/or upon treatment completion when feasible.