Women's experiences with information provision and deciding about fertility preservation in the Netherlands: 'satisfaction in general, but unmet needs'.

OBJECTIVE: It is not well-known how women receiving counselling consultation about fertility preservation (FP) in the Netherlands perceive the information provision about and referral for FP in the oncology setting. The aim of this study was to qualitatively explore women's experiences with the (process of) information provision about the gonadotoxic effects of cancer treatment and about FP and the decision-making process and to obtain their recommendation for improvements. METHODS: Semi-structured interviews with female patients with cancer who had received a counselling consultation on FP (at 18-40 years of age). RESULTS: Thirty-four interviews were held (response rate 64%). Information provision was considered to be important. Overall, women were satisfied with the timing and the content of the information, but women were less positive about the need to be assertive to get information, and the multiplicity of decisions and actions to be carried out in a very short time frame. CONCLUSIONS: Information provision on gonadotoxic effects of cancer treatment and about FP was overall deemed sufficient, timely and important. Women recommended standardization of the information provision, improvement of communication among clinicians and medical centres, and availability of FP-specific patient information materials to improve future information provision processes.

Oncologists' practice and attitudes regarding fertility preservation in female cancer patients: a pilot study in the Netherlands.

PURPOSE: The aim of this study was to assess oncologists' practice and attitudes regarding treatment-related infertility and fertility preservation in female cancer patients of reproductive age. PARTICIPANTS AND METHODS: Recruitment letters with a 7-item questionnaire were sent to 454 oncologists. RESULTS: Two hundred and six of the 454 physicians (45%) responded and 96 questionnaires were used for analysis. The sample included 28 (29%) gynaecologists, 22 (23%) medical oncologists, 19 (20%) surgeons, 16 (17%) radiotherapists and 11 (12%) haematologists. Sixty-two percent of the physicians took action to protect ovarian function before or during gonadotoxic therapy. The most important reason for not offering fertility preservation was "factors concerning the disease". About one-third of the oncologists did not discuss fertility issues. Nearly half of the physicians (43%) would offer fertility preservation options, if they were standardized. High importance was given by almost all physicians (96%) to quality of life in general after gonadotoxic therapy and to the provision of information about fertility preservation options (81%). However, when asked about the importance of infertility after a malignancy, a smaller majority of the physicians (59%) gave it high importance. CONCLUSION: Most physicians considered infertility to be a major issue to be discussed, and most intended to take action to protect ovarian function before or during gonadotoxic therapy.

Timing of fertility preservation procedures in a cohort of female patients with cancer.

OBJECTIVE: Comparison of time intervals from diagnosis to chemotherapy between patients opting for embryo cryopreservation or ovarian tissue cryopreservation. STUDY DESIGN: Retrospective analysis. SETTING: University hospital in the Netherlands. PATIENTS AND METHODS: Thirty-five female patients undergoing fertility preservation procedures before treatment with chemotherapy for cancer. Embryo cryopreservation was performed in 12 patients and ovarian tissue cryopreservation in 23 patients. We investigated differences in time intervals (from diagnosis to start of chemotherapy) between patients opting for embryo cryopreservation and patients opting for ovarian tissue cryopreservation. We calculated time intervals between the moment of diagnosis, the moment of referral, the moment of consultation, the moment of finishing of the fertility preservation procedure and the start of chemotherapy. RESULTS: The median time between diagnosis and referral (median=18 days) and between referral and consultation (median=5 days) was comparable in both groups. A significant difference was found between ovarian tissue cryopreservation and embryo cryopreservation for the time interval between consultation and cryopreservation (p=0.001). Ovarian tissue cryopreservation was completed for half of the patients within 6 days after consultation with the gynecologist, and the hormonal stimulation for embryo cryopreservation was completed for all patients within four weeks (median=18 days), with a median of 11 days of hormonal stimulation. A significant difference was found between ovarian tissue cryopreservation and embryo cryopreservation in the time interval between fertility preservation and start of chemotherapy (median=7 vs 19 days, p=0.019). In sum, the total duration between diagnosis and chemotherapy was significantly shorter for ovarian tissue cryopreservation patients than for embryo cryopreservation patients (median=47 vs 69 days, p=0.042). CONCLUSION: Embryo cryopreservation can be performed within the standard timeframe of cancer care in patients with breast cancer receiving adjuvant chemotherapy, but if delay of the start of chemotherapy is harmful, ovarian tissue cryopreservation can be done within one week.

Female fertility preservation: practical and ethical considerations of an underused procedure.

PURPOSE: Cancer treatments for young women can permanently or temporarily affect fertility. The purpose of this retrospective analysis was to present the clinical experience and ethical considerations of fertility preservation in female oncology patients in a tertiary gynaecological department. METHODS: Since 2002, in 37 patients fertility preservation was performed according to an institutional review board approved protocol in a University hospital in the Netherlands; 33 patients were not treated. RESULTS: Embryo cryopreservation was performed in 10 patients, ovarian tissue cryopreservation in 24, and an ovarian transposition was performed in 3 patients; in one patient combined with an ovarian transplantation and in one patient with ovarian tissue cryopreservation. DISCUSSION: Approved protocols and timing are essential in performing female fertility preservation. Referral for ovarian tissue and embryo cryopreservation is minimal in the Netherlands. Future research focuses on the psychosocial aspects of fertility preservation and explores patients' and professionals' expectations and attitudes regarding fertility preservation and aims to be in line with technical developments.