Barriers and Opportunities of Oncofertility Practice in Nine Developing Countries and the Emerging Oncofertility Professional Engagement Network.

PURPOSE: Oncofertility practice continues to grow in developing countries despite the lack of health care services, especially those related to cancer care. The purpose of this study is to further explore oncofertility practice in these countries and identify opportunities for field-wide coalescence. METHODS: We generated a survey to learn more about oncofertility practice in nine developing countries within our Oncofertility Consortium Global Partners Network-Mexico, Colombia, Guatemala, Argentina, Chile, Nigeria, South Africa, Saudi Arabia, and India. Their responses were collected, reviewed, and discussed. RESULTS: Surveyed centers from the nine developing countries continue to experience a similar set of common challenges, including a lack of awareness among providers and patients, cultural and religious constraints, lack of insurance coverage and funding to help to support oncofertility programs, and high out-of-pocket costs for patients. Despite these barriers, many opportunities exist and there is great potential for the future. CONCLUSION: The current need is to unify the new technologies and best practices that emerge from rural communities and developing countries with those in large metropolitan cities, both domestically (US based) and abroad, into a functional unit: the Oncofertility Professional Engagement Network. The Oncofertility Professional Engagement Network will bridge the gap between domestic and international programs to establish a strong global network in which members share resources, methodologies and experiences and further build cultural competency.

Barriers and Opportunities of Oncofertility Practice in Nine Developing Countries and the Emerging Oncofertility Professional Engagement Network.

PURPOSE: Oncofertility practice continues to grow in developing countries despite the lack of health care services, especially those related to cancer care. The purpose of this study is to further explore oncofertility practice in these countries and identify opportunities for field-wide coalescence. METHODS: We generated a survey to learn more about oncofertility practice in nine developing countries within our Oncofertility Consortium Global Partners Network-Mexico, Colombia, Guatemala, Argentina, Chile, Nigeria, South Africa, Saudi Arabia, and India. Their responses were collected, reviewed, and discussed. RESULTS: Surveyed centers from the nine developing countries continue to experience a similar set of common challenges, including a lack of awareness among providers and patients, cultural and religious constraints, lack of insurance coverage and funding to help to support oncofertility programs, and high out-of-pocket costs for patients. Despite these barriers, many opportunities exist and there is great potential for the future. CONCLUSION: The current need is to unify the new technologies and best practices that emerge from rural communities and developing countries with those in large metropolitan cities, both domestically (US based) and abroad, into a functional unit: the Oncofertility Professional Engagement Network. The Oncofertility Professional Engagement Network will bridge the gap between domestic and international programs to establish a strong global network in which members share resources, methodologies and experiences and further build cultural competency.

Survey of Third-Party Parenting Options Associated With Fertility Preservation Available to Patients With Cancer Around the Globe.

Purpose: In the accompanying article, "Survey of Fertility Preservation Options Available to Patients With Cancer Around the Globe," we showed that specific fertility preservation services may not be offered at various sites around the world because of cultural and legal barriers. We assessed global and regional experiences as well as the legal status of third-party reproduction and adoption to serve as a comprehensive international data set and resource for groups that wish to begin oncofertility interventions. Methods: We provide data on the legalities of third-party assisted reproductive technologies and other family-building options in the 28 oncofertility-practicing countries surveyed. Results: We found regional and country differences that will be important in the development of tailored resources for physicians and for patient brochures that are sensitive to these local restrictions and cultural norms. Conclusion: Because many patients first consult Web-based materials, the formal assessment of the availability of these options provides members of the global oncofertility community with data to which they might otherwise not have ready access to better serve their patients.

Survey of Fertility Preservation Options Available to Patients With Cancer Around the Globe.

Purpose: Oncofertility focuses on providing fertility and endocrine-sparing options to patients who undergo life-preserving but gonadotoxic cancer treatment. The resources needed to meet patient demand often are fragmented along disciplinary lines. We quantify assets and gaps in oncofertility care on a global scale. Methods: Survey-based questionnaires were provided to 191 members of the Oncofertility Consortium Global Partners Network, a National Institutes of Health-funded organization. Responses were analyzed to measure trends and regional subtleties about patient oncofertility experiences and to analyze barriers to care at sites that provide oncofertility services. Results: Sixty-three responses were received (response rate, 25%), and 40 were analyzed from oncofertility centers in 28 countries. Thirty of 40 survey results (75%) showed that formal referral processes and psychological care are provided to patients at the majority of sites. Fourteen of 23 respondents (61%) stated that some fertility preservation services are not offered because of cultural and legal barriers. The growth of oncofertility and its capacity to improve the lives of cancer survivors around the globe relies on concentrated efforts to increase awareness, promote collaboration, share best practices, and advocate for research funding. Conclusion: This survey reveals global and regional successes and challenges and provides insight into what is needed to advance the field and make the discussion of fertility preservation and endocrine health a standard component of the cancer treatment plan. As the field of oncofertility continues to develop around the globe, regular assessment of both international and regional barriers to quality care must continue to guide process improvements.

Informe preliminar con análogos del GnRh de depósito y cirugía en el tratamiento de la endometrosis / Preliminary report with analogous of the GnRh of depot and surgery in the treatment of the endometriosis

El objetivo de este informe es mostrar nuestra experiencia preliminar en el tratamiento sucesivo y combinado quirúrgico y médico con análogos del GnRh de depósito (Lupron 3.75) e hiperestimulación ovárica controlada con gonadotrofinas (H.M.G.H.C.G.) en el tratamiento de la endometrosis. Se evaluó un grupo de 61 pacientes que consultaron por infertilidad en el Instituto de Ginecología y Fertilidad de Bs. As. entre el 1 de octubre de 1992 y el 31 de mayo de 1994. En todas ellas se realizó una laparoscopia para diagnóstico y estadificación de la endometrosis según la clasificación revizada de la Sociedad Americana de Fertilidad, realizándose en el mismo acto los procedimientos quirúrgicos (coagulación, lisis, quistectomia, etc.) según fuera necesario. Todas las pacientes fueron medicadas con Lupron 3.75 una ampolla mensual durante un período de 6 meses posteriores a la cirugía. Del total de 61 pacientes 24 (39,3 por ciento) se embarazaron, de las cuales 15 lo logró en forma espontánea, 13 (54.1 por ciento) en el primer semestre postratamiento 2 (8.3 por ciento) en el segundo semestre. 25 pacientes fueron estimuladas con gonadotrofinas, a partir del 6to. mes de finalizado el Lupron por un período de tres meses y 9 (37.5 por ciento) de ellas lograron el embarazo. En conclusión los resultados obtenidos sugieren que el tratamiento quirúrgico y médico con análogos del Gn-Rh y gonadotrofinas son útiles en el tratamiento de la endometrosis, permitiendo acortar el período en que se obtiene el embarazo logrando además una adecuada tolerancia y aceptación por parte de la paciente

Resultados en el tratamiento de la endometrosis con cirugía y análogos del GnRh de depósito / Surgical treatment of the endometrosis compared to the treatment whith GnRh analogues

Muestra nuestra experiencia en el tratamiento secuencial y combinado, quirúrgico y médico con análogos del GnRh de depósito (Lupron 3,75), hiperestimulación ovárica controlada con gonadotrofinas HMG-HCG y posterior Second Look laparoscópico con técnica de transferencia intratubaria de gametos. Se evaluó 61 pacientes que consultaron por infertilidad en el Instituto de Ginecología y Fertilidad de Bs. As., entre el 1º de octubre de 1992 y el 30 de diciembre de 1994. En todas ellas se realizó una laparoscopia para el diagnóstico y estadificación de la endometrosis según la clasificación revisada de la Sociedad Americana de Fertilidad, realizándose en el mismo acto los procedimientos quirúrgicos de coagulación, lisis o quistectomía según fuera necesario. Todas las pacientes fueron medicadas con Lupron 3,75 de aplicación mensual durante un período de 6 meses posteriores a la cirugía. Del total de 61 pacientes, 29 (47,5 por ciento) se embarazaron con tratamiento quirúrgico, médico e hiperestimulación ovárica, de las cuales 17 (59 por ciento) lo logró en forma espontánea, 13 (44,8 por ciento) en el primer semestre y 4 (13,7 por ciento) en el segundo semestre postratamiento. Sobre 35 pacientes estimuladas, a partir de los 6 meses de finalizado el Lupron por un período de 3,2 ciclos se embarazaron 12 (41 por ciento). A 10 pacientes se les realizó al cabo de un año de finalizado el tratamiento con análogos un second look laparoscópico con técnica de transferencia intratubaria de gametos, logrando el embarazo en 5 pacientes (50 por ciento). Los resultados obtenidos sugieren que el tratamiento propuesto ha sido útil en este grupo de pacientes, logrando además una adecuada tolerancia y aceptación por parte de las mismas