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Doctors Less Likely to Offer Fertility Information to Some Women Before Cancer Therapy

May 2, 2013

Written By Robin Warshaw, Contributing Writer
Reviewed By Lynn Westphal, MD, FACOG

A recent study found that premenopausal women diagnosed with cancer are less likely to receive counseling about, or access to, fertility preservation if they belong to certain groups.  

The study, published in the journal Cancer, was conducted by researchers at the University of California at San Francisco School of Medicine.

Background and Reason for the Study

Women of reproductive age who have cancer may receive treatment, such as chemotherapy, that can affect future fertility.

In recent years, methods to preserve fertility have improved, allowing some women to freeze eggs or embryos. This makes it possible to protect fertility before treatment begins, rather than seeking help afterward.

Still, very few women—as low as 2 percent in one study—use these services before cancer treatment. Many never even talk with their doctors about fertility issues before therapy begins.

The researchers wanted to find out if socioeconomic and demographic factors were barriers to counseling and use of fertility services.  

Study Structure

Using a California state cancer registry, the researchers randomly selected 2,532 women who were between age 18 and 40 at diagnosis and had leukemia, Hodgkin disease, non-Hodgkin lymphoma, breast or gastrointestinal cancer.

Of the 1,041 women who responded to the study survey, 918 (including 223 with breast cancer) reported having treatment that could affect fertility. The survey was available in English and Spanish, online and on paper.

The registry and survey noted factors such as:

  • Age at diagnosis
  • Year of diagnosis
  • Ethnicity
  • Income
  • Education
  • Marital status (single or partnered at diagnosis)
  • Sexual orientation
  • Urban or rural residence
  • Whether the woman had one or more children at diagnosis
  • If the woman had wanted to have a child after treatment

Each woman was asked if:

  • Her cancer team had counseled her about the fertility risks of treatment
  • She pursued fertility preservation under the care of a reproductive endocrinologist, a doctor who is a fertility specialist

Findings

Compared to those with other cancers, the women with breast cancer were on average older at diagnosis (36) and when surveyed (47) and further past diagnosis (10.8 years). More (73 percent) had children before treatment.

About 47 percent of women with breast cancer wanted children after treatment, versus 49 to 63 percent of other participants.

Looking at the entire group, the study determined:

  • 61 percent had been counseled about treatment risk to fertility
    • Women had a higher chance of being counseled if they:
      • Were age 35 or younger at diagnosis
      • Desired future children at diagnosis
      • Had a higher education level (bachelor’s degree or above) 
    • No significant differences in counseling were found by number of children, marital status, household income, ethnicity, sexual orientation or population density 
  • 4 percent had fertility preservation (freezing eggs, etc.)
    • Women who were more likely to pursue fertility preservation were:
      • Younger at diagnosis
      • Wanted future children at diagnosis
      • Childless before diagnosis
      • Had higher education level

Few Latinas—and no African-Americans or women who identified as lesbian, bisexual, transgender or other—had fertility preservation. More research is needed to understand why.

Limitations

Few participants had incomes lower than $30,000. Because household income may influence both access to counseling and use of fertility services, the researchers noted their findings may not accurately reflect differences among groups.  

What This Means for You

You might not know whether you want to have children. Yet it’s important to know how your treatments might affect your  future fertility.

Talk with your providers about your situation. Ask directly about fertility effects, especially if you are in one of the groups this study identified as being less likely to hear about such risks.

If your fertility could be affected by treatment, a reproductive endocrinologist can advise you about fertility preservation before therapy begins. Even if you already had treatment, a reproductive endocrinologist can help you learn your fertility status and find out about methods that might be right for you.

Fertility preservation can be costly and is often not covered by health insurance. Find out what services you might need, then talk with your insurer before beginning fertility treatment.

Adoption is also a good path to parenthood—one that is more open than before to women who have been diagnosed with cancer. Hear more about fertility options and adoption after breast cancer.

JM Letourneau, JF Smith, EE Ebbel et al. Racial, Socioeconomic, and Demographic Disparities in Access to Fertility Preservation in Young Women Diagnosed With CancerCancer, 2012; 118(18): 4579-4588.

This article was supported by Cooperative Agreement Number DP11-1111 from The Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention.

Denver, CO  ·  September 13, 2014

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