Fertility Preservation
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Fertility Preservation

New guidelines encourage female and male cancer patients to seek options

By Sue Rochman

When cancer is diagnosed, patients and oncologists typically focus on treating the disease, and as a result, critical questions about fertility can go unasked or unanswered. If this happens, cancer patients may miss the one opportunity they have to preserve their ability to have a biological child.

But it doesn’t have to be that way. That’s the message for oncologists and patients from the authors of new fertility preservation guidelines published in the June 20 issue of the Journal of Clinical Oncology.

“These recommendations close a huge gap between the fields of oncology and fertility,” says reproductive endocrinologist Kutluk Oktay of the Center for Reproductive Medicine and Infertility at New York–Presbyterian Hospital in New York City, who co-authored the new guidelines. “Many cancer treatments have an impact on fertility. Yet many oncologists are not aware of, or don’t know how to advise patients about, methods of preserving fertility.”

Both women and men may become infertile after cancer treatment. In women, surgeries required to treat cervical, ovarian or uterine cancer may prevent them from conceiving or bearing children. In addition, chemotherapy and radiation treatments may damage a woman’s eggs, cause her to stop ovulating or make her enter menopause prematurely. In men, the cancer itself may cause infertility, while chemotherapy and radiation treatments may decrease the number and quality of available sperm.

“Once fertility is taken away, it may be hard to restore,” says oncologist Patricia Ganz of the Jonsson Comprehensive Cancer Center at the University of California at Los Angeles. “These guidelines heighten awareness and should be part of treatment planning and be used in an anticipatory way.”

Not all chemotherapy drugs work the same way, and some are more likely than others to cause infertility. Studies have found that drugs which fight cancer by acting on a cell’s DNA, such as Cytoxan (cyclophosphamide) and Leukeran (chlorambucil), are more likely to cause infertility than chemotherapy drugs that block the metabolism of cancer cells, such as Rheumatrex (methotrexate), or those that inhibit cancer cells’ growth by stopping cell division, such as Oncovin (vincristine).

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