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Women get less information on post-cancer fertility

Last Updated: 2012-05-25 15:20:13 -0400 (Reuters Health)

By Amy Norton

NEW YORK (Reuters Health) - Cancer treatment can sometimes lead to infertility, but young women are less likely than young men to be informed of that risk, a new study suggests.

Swedish researchers found that of nearly 500 cancer survivors ages 18 to 45, most men -- 80 percent -- said their doctor had told them their chemotherapy could affect their future fertility.

But only 48 percent of women said the same, the team reports in the Journal of Clinical Oncology.

What's more, women were far less likely to have received information about options for preserving their fertility. Only 14 percent said they did, versus 68 percent of men.

That gap, researchers say, is likely related to the fact that preserving fertility is more complicated in women than men, and the techniques for doing so are not as widely available.

But regardless, women should still be informed, said senior researcher Claudia Lampic, of the Karolinska Institute in Stockholm.

"Even in cases when fertility preservation could not be performed, patients -- and in particular, women -- should be informed about their risk of decreased fertility and their risk of entering menopause prematurely," Lampic told Reuters Health in an email.

A range of cancer therapies can affect fertility. Some chemotherapy drugs, for instance, can damage a woman's eggs or a man's ability to produce normal sperm.

Radiation therapy near the reproductive organs, or to the brain, can also harm fertility, as can hormonal therapies for breast, prostate and certain other cancers.

"This study is yet (more) evidence of healthcare disparity when it comes to fertility preservation," said Dr. Kutluk Oktay, a post-cancer fertility expert who was not involved in the research.

Other studies have found that cancer patients' likelihood of getting fertility information varies based on where they live, or even by medical center, explained Oktay, who directs the division of reproductive medicine and infertility at New York Medical College in Valhalla.

"Not only there are tremendous differences between geographical areas as to who receives fertility preservation information and treatment, but there seems to be a gender gap as well," Oktay said.

He agreed that it's likely related to differences in how male and female fertility are preserved.

Men can have their sperm frozen and banked before cancer treatment -- which is a relatively quick, simple process, though there is a cost.

According to the American Cancer Society, the cost of sperm banking typically tops $1,500, which includes three sperm donations and a few years of storage. Insurance often does not cover fertility preservation for cancer patients.

For women, the most common way to preserve fertility is to have in vitro fertilization to create embryos, which are then frozen and banked. It's also possible to freeze a woman's eggs or ovarian tissue, but those techniques are still considered experimental and it's not clear how well they work.

The total cost of those procedures can run from $8,000 to $24,000, and they are less widely available than sperm banking.

Another concern with women is that harvesting eggs generally means using hormonal treatments to stimulate the ovaries. Since that raises a woman's estrogen levels, women with breast or uterine cancer have traditionally not been offered embryo or egg freezing.

That is changing, however, said Oktay -- who has developed new regimens for stimulating egg production that do not boost women's estrogen levels.

But they are only just coming into use.

"The options are out there," Oktay said. "But the utility is still patchwork right now."

The current findings are based on 484 patients who had chemotherapy for leukemia, lymphoma, or breast, testicular or ovarian cancers between 2003 and 2007.

Things might be different now, Lampic's team notes, since there have been advances in fertility preservation for female cancer patients.

Recommendations from the American Society of Clinical Oncology (ASCO) call for doctors to address the possibility of fertility problems in all reproductive-age patients before starting cancer treatment, and to be ready to talk about options like embryo-freezing.

But it's been clear for some time that those discussions may or may not take place. According to Oktay, "there are definitely disparities" among cancer centers. He said ASCO is working on new education materials to help ensure that more doctors can talk about the issue.

A recently published U.S. survey of women diagnosed with cancer when they were 40 or younger found that more than half said they still wanted to have children at the time of their diagnosis. (See Reuters Health story of March 26, 2012).

For now, Oktay said, if a cancer patient is concerned about future fertility, and her doctor does not bring up the issue, it's time to ask questions.

"Be proactive, and ask 'Will this treatment cause problems with my fertility?'" he advised.

If your doctor is not comfortable with fertility issues, Oktay added, you can ask for a referral to someone who is.

Lampic agreed. "Women with cancer who wish to have children in the future should definitively bring up this issue with their doctors and healthcare providers in general."

SOURCE: http://bit.ly/K5EXFw Journal of Clinical Oncology, online May 14, 2012.

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