2021 Volume 46 Issue 4 Pages 273-278
In recent years, more cancer patients are achieving long-term survival owing to advances after cancer treatment. The effects of treatment on fertility are a great concern to many young people. For some, the loss of a future child may be more distressing than a cancer diagnosis itself, and indeed, a cancer diagnosis does not change the desire for biological children. Consultation with fertility specialists before the initiation of cancer treatment offers the potential to optimize the potential of becoming biological parents in the future and minimize the effects of fertility impairment on quality of life (QOL).
In 2006, Woodruff’s group established the Oncofertility Consortium, which is a nationwide network for coordination of oncologic and reproductive healthcare, and they also published clinical pocket guides to oncofertility for doctors and patients.
In Japan, there has been no comprehensive guideline on fertility preservation in patients with specific cancers. Clinical oncologists in Japan should recognize the importance of fertility preservation in children, adolescents, and young adults (AYA) with cancer to improve survivorship. In 2015, the Japan Society of Clinical Oncology (JSCO) started to develop guidelines that focused on cancer treatment while taking fertility preservation into consideration. In 2017, JSCO completed the “2017 Clinical Practice Guidelines for Fertility Preservation in Pediatric, AYA Cancer Patients”.
However, fertility preservation sometimes has to be abandoned depending on the stage of the cancer and the general condition of the patient, because fertility preservation procedures may unacceptably delay cancer treatment or be too risky for the patient. The clinician’s objective in most cases is to make a professional judgment regarding urgency of treatment and assess the likelihood of successful preservation in an ill individual. It is conceivable that clinicians considered discussions regarding future fertility were not considered appropriate.
The importance of the role of the clinician in discussions and decisions regarding fertility preservation cannot be underestimated.
Patients and their parents want information regarding risks, referral to fertility specialists has been contributing to lower regret and greater QOL for patients after cancer treatment and those who undergo fertility preservation believe they had made the right decision.
In addition, important aspect of fertility counseling should include the reassessment of fertility after treatment has completed. For male, this can include reassessment of sperm count and motility, and for women, pre- and post-treatment blood test of anti-Mullerian hormone (AMH) can provide an indication of ovarian function.
This article reviews the latest information concerning clinical practice guidelines around the world, including the American Society of Clinical Oncology guidelines that were to be published in neurosurgical field.
