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Fertility preservation for girls with cancer ‘haphazard’

Awareness of and access to services is poor in UK despite NICE guidance, say experts

Louise Prime

Thursday, 01 December 2016

Fertility preservation for girls and young women with cancer is ‘haphazard’ in the UK despite clear guidelines from the National Institute for Health and Care Excellence (NICE), according to experts writing in The BMJ today. They argue in their editorial* that awareness of and access to services remain poor – many patients do not even know that fertility preservation is possible when they undergo cancer treatment, and funding is often lacking. They call for better routine data collection and good trials, to give girls and women a fully informed choice.

Richard Anderson, professor of clinical reproductive science and Melanie C Davies, consultant gynaecologist, point out that because treatment advances have enabled so many people to survive cancer in childhood and adolescence, there is an increasing number of adult cancer survivors for whom long-term consequences, including loss of fertility, are important. In men, fertility preservation is relatively simple, involving the freezing of sperm; but for women it is more complex and invasive, involving the freezing of oocytes, embryos or now even ovarian tissue.

They cite the NICE guidance on fertility, which recommends offering oocyte or embryo cryopreservation to women of reproductive age (including adolescent girls) before cancer treatment that is likely to make them infertile provided that they are well enough, it will not worsen their condition, and enough time is available.

They report: “Provision is particularly haphazard across the UK. Despite the NICE recommendations, there are substantial obstacles in terms of access and funding. Patients may not know that fertility preservation is possible because awareness among oncologists is variable and referral pathways are often lacking. Oocyte storage is not yet available in all IVF laboratories, and storage of ovarian tissue remains very limited in the UK, although there are good examples of national networks in Europe. In some areas, NHS funding is taken from infertility services; in others funding is requested from commissioners on a case-by-case basis.” Furthermore, access criteria to fertility treatment sometimes exclude women who already have children, have a high body mass index, or who smoke.

The authors also point out that there is poor evidence regarding the likelihood of a successful birth after fertility preservation in cancer survivors – it is currently based on small case series – and although the assisted reproduction sector in the UK already records much information it does not, for example, include the reason for oocyte cryopreservation.

They conclude: “There is an urgent need to improve information for patients, education for oncologists, and equity of funding, to overcome the barriers to more widespread use of fertility preservation in the UK.”

* Anderson RA, Davies MC. Editorial: Preserving fertility in girls and young women with cancer. BMJ 2016; 355: i6145 doi: 10.1136/bmj.i6145.

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