Fertility preservation can be an important choice for patients undergoing a procedure such as cancer treatment at a young age. Patients of any gender who will undergo medical treatment that could compromise their future fertility should know that there are options available. Here, we summarize some of the most frequently asked questions about preserving fertility for future family planning.
- Are there fertility preservation guidelines for cisgender women undergoing cancer treatment? Patients of childbearing age who are assigned female at birth and face cancer treatment should consult with a reproductive endocrinologist who is familiar with the effects of specific cancer treatments and how best to overcome these hurdles. Different approaches fit different cancer treatments. For example, a bone marrow transplant or radiation near the abdomen can damage the ovaries, so cryopreservation of ovarian tissue may be appropriate.
- How do I know if there's a fertility preservation procedure for my patient's situation? Patients of childbearing age may be interested in procedures that preserve fertility, but these are not always appropriate. Physicians should carefully weigh whether patients can safely undergo fertility-sparing surgery based on the cancer's stage and whether it is likely to recur. For example, cervical conization may be appropriate for some cervical cancers, but not all. However, even a conization procedure can cause cervical stenosis or incompetent cervix — each of which may affect a patient's future fertility and ability to carry a pregnancy.
- What happens to cisgender men's fertility after chemotherapy? More and more young people are surviving a cancer diagnosis, but many young cisgender men do not receive adequate counseling on their options to preserve their future fertility after cancer treatment. Clinicians should be aware of the full range of possibilities, such as sperm cryopreservation and tissue banking, as well as how to sensitively broach this topic with young patients who may not have considered fertility planning for adulthood.
- Do all patients lose fertility after cervical cancer? Cervical cancer does not always hinder a person's chances of carrying a child. However, some treatments for cervical cancer can cause future pregnancies to be labeled as high risk. Some cancers will be too aggressive or at a stage where fertility-sparing surgery is not possible, but some patients can undergo oocyte preservation prior to beginning their cancer treatment.
- What are the fertility options for transgender men? Fertility preservation options for transgender men are much the same as for cisgender women. Two of these methods include oocyte cryopreservation and ovarian tissue cryopreservation. Physicians should be prepared to provide counseling based on where patients are in their transition as well as where they want to go. For instance, trans men who have not had a hysterectomy but are taking testosterone may still become pregnant and may or may not wish to do so.
The key to counseling these patients in fertility preservation is to bring up the subject proactively. Patients may hear the word "chemotherapy" and assume that their childbearing years are over, and this is not always the case.
