Decision Making and Fertility Preservation in Cancer Patients

Infertility following cancer treatment in cancer patients is consequently a source of psychosocial and emotional distress and may severely impact quality of life into survivorship [1,2]. Therefore, storing the potential or material to have biological children after cancer treatment can be of high importance to many cancer survivors and help them adjust to life after cancer therapy [3]. There are various fertility preservation (FP) techniques with the aim of saving the possibility of childbearing capacity in prepubertal and pubertal cancer patients [4]. It is important that patients are adequately supported to determine which options are best suited to their individual situation [5]. Decisions surrounding FP in children, adolescents, and adults can be difficult due to the distress of a cancer diagnosis, time constraints for decision-making, and lack of efficacy data, oncological treatment planning and preparation, and possible fertility treatment financial barriers, etc. [6,7]. Given the nature of the multi-step decision-making process, the key question is who decides to preserve fertility in cancer patients; oncologists, reproductive specialists, embryologists, other health care providers, or the patient. American Society for Clinical Oncology (ASCO) outlines “oncologists should address the possibility of infertility with patients treated during their reproductive years and be prepared to discuss possible FP options or refer appropriate and interested patients to reproductive specialists” [8]. Therefore, the potential risk should be discussed with all pubertal or post-pubertal patients at the time of diagnosis. It has been suggested that the discussion should include an explanation of potential methods of FP [9]. Given the recommendation, all health care providers and physicians involved in the FP process in cancer patients are only responsible for keeping the patient fully and comprehensively informed and referring the patient to a fertility specialist. It is up to the patient to make the decision to use FP.