Fertility preservation counselling in Dutch Oncology Practice: Are nurses ready to assist physicians?

Cancer and its treatments may result in impaired fertility, which could cause long-term distress to cancer survivors. For eligible patients, fertility preservation (FP) is available to secure future reproductive potential. Many physicians, however, feel inhibited about discussing FP. Oncology nurses may serve as an initiator for discussing the subject and provide additional support. Our aim was to investigate their knowledge about FP, the way they apply this, and possible barriers to discussing FP with patients of reproductive age. A questionnaire was administered via mail, Internet and the Dutch Oncology Nursing Congress. Four hundred and twenty-one oncology nurses participated, a third of whom (31.1%) had "sufficient" knowledge of FP. Twenty-eight per cent of participants reported that they "never/hardly ever" discussed FP; 32.2% "almost always/always." FP discussions were more frequently performed by graduate nurses, academic nurses, experienced nurses and nurses with sufficient knowledge. Reasons for not discussing FP were a "lack of knowledge" (25.2%), "poor prognosis" (16.4%) and "lack of time" (10.5%). In conclusion, several obstacles may result in FP not being routinely discussed, specifically a lack of knowledge. Yet nurses feel responsible for addressing the issue, indicating that assistance with FP discussions should be encouraged. Educational training about FP is recommended.

Preservación de la fertilidad de la mujer. Vitrificación de ovocitos / Fertility preservation of women: oocyte vitrification

La criopreservación de ovocitos humanos permite retrasar la fertilidad y es también una opción para mujeres que van a someterse a un tratamiento oncológico/autoinmune. Permite también crear un banco de ovocitos para la donación, en los centros de reproducción asistida. La legislación permite la utilización de ovocitos criopreservados durante toda la vida fértil de la mujer, con lo que su conservación podría prolongarse hasta los 48-50 años. La vitrificación de ovocitos consiste en un método de congelación ultrarrápido en el que se utilizan crioprotectores para evitar la formación de cristales de hielo en el interior de la célula. El tratamiento para el proceso de vitrificación de ovocitos es similar a un tratamiento de fecundación in vitro, y finaliza en el momento de la obtención de los óvulos. Los óvulos así conseguidos se clasifican en el laboratorio según su madurez y calidad. Los aptos serán criopreservados mediante la técnica de vitrificación y se mantendrán en tanques de nitrógeno líquido hasta su utilización con fines reproductivos (AU)

Cryopreservation of human oocytes to delay fertility also be an option for women who are going to be subjected to a cancer/autoimmune treatment. It allows for creating a bank of oocytes for donation in assisted reproduction centers. The legislation allows the use of cryopreserved oocytes throughout the reproductive life of women with what conservation could last up to 48-50 years. Oocyte vitrification is a ultrafast freezing method in which cryoprotectants are used to prevent the formation of ice crystals within the cell. Treatment for oocyte vitrification process is similar to IVF treatment, ending at the time of obtaining the ova. The eggs obtained in the laboratory are classified according to maturity and quality. The apartments will be cryopreserved by vitrification technique tanks and maintained in liquid nitrogen until used for reproductive purposes (AU)

Repair of the threatened feminine identity: experience of women with cervical cancer undergoing fertility preservation surgery.

BACKGROUND: Fertility preservation is important for women of reproductive age with cervical cancer. The underlying reasons behind suboptimal reproductive results after successful fertility-preserving surgery have not yet been fully revealed. OBJECTIVE: The objective of this study was to explore the experience of fertility preservation with radical trachelectomy from the perspective of women with cervical cancer. METHODS: We conducted interviews with women with cervical cancer who underwent radical trachelectomy using a Grounded Theory methodology with a theoretical framework of symbolic interactionism. RESULTS: Our findings articulate a process in which feminine identity is first threatened by a diagnosis of cancer, then repaired by fertility preservation with radical trachelectomy, and finally reconstructed after the surgery, through interactions with self, others, and external events in women with cervical cancer. Feeling incomplete as a woman because of the loss of the uterus was a critical factor in the women's feeling that their feminine identity was threatened. Thus, fertility preservation was significant for these women. The meaning of fertility preservation varied among the women, and their life perspectives were therefore distinct after the surgery. CONCLUSIONS: Women with cervical cancer who undergo radical trachelectomy experience an identity transformation process, and child bearing is not the only expected outcome of fertility preservation. IMPLICATIONS FOR PRACTICE: Nurses should coordinate care through the cancer trajectory. Understanding the identity transformation process helps nurses to assess patients' needs and provide appropriate individual care.