Body image disturbances in adolescent and young adult cancer patients confronting infertility risk and fertility preservation decisions.

PURPOSE: Body image is a major psychosocial concern for all cancer patients but can affect the adolescent and young adult (AYA) population in distinct ways. Similarly, the prospect of infertility and the fertility preservation process can create additional stress during cancer treatment. Discussions regarding infertility inherently implicate the body and its reproductive function, but downstream effects on self-perception have not been previously described. The aim of this study was to explore the experiences of AYAs as they considered their risk of infertility and options for fertility preservation (FP), specifically the ways in which this impacted body image and FP decision-making. METHODS: AYA cancer patients (n = 27) aged 12-25 years whose cancer and treatment conferred risk of infertility were recruited through electronic health record query at an NCI-Designated Comprehensive Cancer Center. Participants completed semi-structured interviews, which were recorded, transcribed, and deductively coded for themes related to information needs, knowledge of treatment effects on fertility, and reproductive concerns after cancer. Emergent, inductive themes related to body image were identified. RESULTS: Body image concerns, related to both physical appearance and body functioning emerged. Common concerns included anticipating change as it pertains to the body and its functions, physical discomfort, fear of judgment, and meeting expectations of the body. While these themes are broad in nature, they have been previously explored in relation to body image in general and their emergence in the oncofertility space provides guidance for further optimization of infertility and fertility preservation discussions. CONCLUSIONS: AYA cancer patients experience a multitude of body image related disturbances when faced with the possibility of infertility and fertility preservation. In identifying and exploring these themes, future opportunities for improving oncofertility practice and discussions among AYAs with a focus on body image positivity are called upon.

Physician and patient use of and attitudes toward complementary and alternative medicine in the treatment of infertility.

OBJECTIVE: To determine use of and attitudes toward complementary and alternative medicine (CAM) among infertility patients and subspecialty physicians. METHODS: Infertility patients were asked to complete anonymous written surveys at an academic infertility practice; members of the Society for Reproductive Endocrinology and Infertility were electronically surveyed. Both groups were assessed regarding their use of and attitudes toward CAM. RESULTS: The response rate was 32.1% (115/358) among patients and 22.6% (225/995) among physicians (P<0.05). In total, 105 (91.3%; 95% confidence interval [CI], 85.8-96.2) patients used CAM, and 84 (73.0%; 95% CI, 64.9-81.1) regarded it as beneficial to their fertility treatment. However, only 30 (26.1%; 95% CI, 18.0-34.0) patients reported CAM use to physicians, with the most common reason being that they were "never asked." Overall, 202 (89.8%; 95% CI, 85.9-93.8) physicians reported inquiring about CAM. CONCLUSION: Significant discrepancies exist between subfertile patients and physicians in attitudes toward the use of CAM. The current prevalence of CAM use among infertility patients requires greater physician attention and justifies further study on the risks and benefits of integrating CAM into the biomedical treatment of infertility.

A systematic review of the evidence for complementary and alternative medicine in infertility.

BACKGROUND: The use of complementary and alternative medicine (CAM) by patients and physicians has increased markedly in recent years. Many case reports, case series, and uncontrolled trials of varying quality have been completed; however, there is now a slowly increasing number of randomized controlled trials (RCTs) examining the use of CAM. OBJECTIVES: To identify, survey, and review RCTs investigating the use of CAM for infertility treatment. SEARCH STRATEGY: The MEDLINE and Cochrane databases were electronically searched. SELECTION CRITERIA: RCTs examining modalities for treatment or improvement of health status were reviewed. DATA COLLECTION AND ANALYSIS: RCTs were included based on use of objective measures, articles written in English, availability through the University of Michigan database, and clear published clinical outcomes. MAIN RESULTS: Thirty-seven articles assessing a variety of CAM modalities met inclusion criteria. Acupuncture, selenium supplementation, weight loss, and psychotherapeutic intervention had 3 or more studies demonstrating beneficial effect. Other interventions had been studied less and evidence for them was limited. CONCLUSIONS: Although there is preliminary evidence of the effectiveness of some CAM interventions among infertile patients, many of these interventions require further investigation before they can be considered for routine clinical use.