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Oncology Care and Gynecologic Concerns
Published in S Paige Hertweck, Maggie L Dwiggins, Clinical Protocols in Pediatric and Adolescent Gynecology, 2022
Many treatments for childhood cancers result in gonadal damage (see Chapter 18, “Fertility Preservation”)Initial referral prior to start of treatment is optimalDue to rapidly changing evidence and practices, referral to specialist in oncofertility is preferredFor the adolescent female, oocyte/embryo and ovarian tissue cryopreservation are standard of careFor the prepubertal girl, only ovarian tissue cryopreservation is an optionEven if menses initially returns after treatment, some may experience primary ovarian insufficiency (POI) several years laterPatients should track menses, and if irregular, proceed with evaluation of ovarian function with FSH, estradiol, AMH, ± antral follicle count
Communicating About Technical Failures in Assisted Reproductive Technology
Published in Fritz Allhoff, Sandra L. Borden, Ethics and Error in Medicine, 2019
Rashmi Kudesia, Robert W. Rebar
In the United States, 10–15 percent of heterosexual couples face infertility (Martinez, Daniels, Febo-Vazquez 2018). Those that fail less aggressive therapy make up the bulk of those utilizing ARTs. However, an increasing number of women are pursuing fertility preservation via oocyte cryopreservation (Petropanagos, Cattapan, Baylis, and Leader 2015), either because of anticipated delayed childbearing or growing utilization of oncofertility treatment, namely the option for fertility preservation before or during radiation or chemotherapy for the treatment of cancer (Barlevy, Wangmo, Elger, and Ravitsky 2016). LGBT individuals may also electively utilize ARTs to allow for oocyte preservation prior to oophorectomy in transmen or to allow for reciprocal IVF in lesbian couples, in which both women can participate biologically by one donating eggs to the other, who then carries the pregnancy. In 2016, 263,577 ART cycles were started in the United States, with 25 percent (65,840) being egg or embryo banking cycles (CDC 2018). With 76,930 infants born in that same year conceived via ART, out of 3.9 million liveborn deliveries, ART cycles accounted for 1.9 percent of births in that same year, continuing a general upward trajectory of ART births as a percentage of all U.S. births (Martin et al. 2018).
Use of in vitro maturation in a clinical setting Patient populations and outcomes
Published in David K. Gardner, Ariel Weissman, Colin M. Howles, Zeev Shoham, Textbook of Assisted Reproductive Techniques, 2017
Yoshiharu Morimoto, Aisaku Fukuda, Manabu Satou
Although at present it may be premature to offer IVM to all types of patients, IVM is definitely a safer option than IVF in patients who are extremely sensitive to gonadotropins, because it completely avoids the risk of OHSS. From the point of view of safety, IVM should be applied for any male factor-related infertility such as testicular sperm extraction and ICSI cases without female disorders such as PCOS/PCOs (15,24,25,42,49,65–69,71) or normal ovaries/ regular-cycling women (10,17,20,50,71,72). Vitrification of human embryos has become a routine ART method. Not only cleaved embryos, but also oocytes have been successfully vitrified (38,39,88,89). Application of frozen cycles in IVM will improve the clinical outcome because of improved uterine receptivity. Moreover, cryopreservation of either immature oocytes or mature oocytes is a safer ART for female cancer patients, especially those with breast cancer (90). Recently, oncofertility is a hot topic in reproductive medicine. IVM is an indispensable technology for frozen ovarian tissues from cancer patients or is suitable for urgent retrieval of multiple oocytes without stimulation when patients have short time before emergency chemotherapy or surgery (91).
Fertility preservation decisions in young women with breast cancer: a qualitative study of health care professionals’ views and experiences
Published in Human Fertility, 2022
Kathryn Brown, Natalie Armstrong, Neelam Potdar
The burden of infertility after cancer is a potentially preventative problem dependent on adequate information giving from HCPs. The developing field of oncofertility, and its role in incorporating both oncological management and fertility consequences of treatment, is an important and vital part of comprehensive multi-disciplinary management of women to ensure patient-centred care. This also helps to prevent negative psycho-social effects ensuring appropriate information provision, informed decision making and autonomy (Vu et al., 2017). The differences in women’s desires and expectations regarding FP and the information they require reinforces the need for HCPs to be informed and ready to respond appropriately. This study aimed to qualitatively explore HCPs’ views and opinions on FP; particularly on how they offer FP discussions based on their knowledge, opinions, attitudes and experience.
Female fertility in the cancer setting: availability and quality of online health information
Published in Human Fertility, 2020
Anne Marie de Man, Alexandra Rashedi, Willianne Nelen, Antoinette Anazodo, Alfred Rademaker, Saskia de Roo, Catharina Beerendonk, Teresa K. Woodruff
In this study, we aimed to assess the availability of English written oncofertility information online and its quality, on websites of oncology, fertility and oncofertility organizations, globally. Patients want their fertility addressed sensitively at the time of diagnosis and backed up by access to written or web-based patient information or a fertility specialist (Muller et al., 2017; Wilkes, Coulson, Crosland, Rubin, & Stewart, 2010). Several studies claim that websites can improve knowledge and help in decision-making (Balthazar et al., 2012; Daniluk & Koert, 2015; Ehrbar et al., 2018; Garvelink et al., 2013; Hershberger et al., 2013; Jona & Gerber, 2010; Lewis, 1999). Unfortunately, fewer than half of oncologists refer patients of childbearing age for fertility preservation (Quinn et al., 2009), and few (13%) provide their patients with educational materials on fertility preservation (Quinn et al., 2012). Since there is an information gap on oncofertility information, and options for preservation are not always discussed timely since the focus is likely on the cancer treatment itself, the internet might be the only source of information regarding a patients’ fertility preservation options. Generally, patients view the internet as an additional source of information that may help them better understand their doctors’ recommendations and advice. Furthermore, it has been found that seeking health information online may actually improve the patient–physician relationship (Tan & Goonawardene, 2017). To address these patient needs, we assessed the current state of Internet resources using validated tools.
Recent advances in fertility preservation and counseling for female cancer patients
Published in Expert Review of Anticancer Therapy, 2018
While many clinicians are widely informed about the risk to their patients’ fertility caused by cancer treatment, there are still many factors that impede appropriate discussion, referral, or exploitation of services designed to provide adequate oncofertility support to females of reproductive age [9]. Fortunately, efforts are now intensifying all over the world to establish oncofertility programs and increase access of newly diagnosed patients to fertility preservation options [35]. Indeed, the presence of a dedicated oncofertility clinic with an interdisciplinary fertility preservation team, including a designated oncofertility navigator, is known to increase physician referrals for fertility preservation and decrease the mean time to consultation [35,36]. Such endeavors lead to improvements in the clinical application of fertility preservation strategies among young cancer patients [37], with development of online decision-aiding systems that appear to be well-accepted tools in decision-making for both patients and professionals [38].