Successful advances in cancer diagnostics and management have led to earlier detection of disease and more effective treatment. In the UK since the early 1990’s, the incidence of new cancers has been greatest in those aged under 24 years (incidence increased by 23%). This age group also has one of the highest 5-year net survival rates for nearly all cancers, and the largest fall in mortality since the 1970’s (64% decrease in mortality rate).1 This improved survival has led to an increasing focus on survivorship and returning to a normal life after treatment.
The diagnosis of cancer is a devastating and life changing moment. In an instant the world is turned upside down, and so many things that were taken for granted, or future worries, are brought tumbling into the forefront. In this whirlwind of uncertainty and fear, future fertility is often the furthest thought in the mind. However, given the significant potential impact of both the cancer and its treatment on sexual function and fertility, it is an important topic to broach from the start.
The best outcome with fertility preservation is before any treatment is started. NICE recommends that at diagnosis, the impact of cancer and its treatment on future fertility should be discussed.2 Taking a proactive approach not only allows a potentially better chance of fertility preservation, but also an opportunity to remove a source of significant subsequent distress.
Studies have shown that infertility alone is associated with psychological distress and increased levels of depression. Superimposed on a cancer diagnosis, infertility can significantly increase the stress on the patient and their partner. Planning and discussion about fertility preservation can therefore alleviate this source of emotional distress and improve subsequent quality of life.3,4
Although fertility is often thought of as a concern primarily for women, men can be equally interested and affected by a loss of their fertility potential.5 In some men, the loss of fertility may have a more significant impact due to cultural and religious beliefs, where paternity remains a sign of masculinity and virility, or where alternatives such as donor sperm use are not an acceptable path. In these circumstances, subsequent infertility can have more wide reaching effects on life and psychosexual wellbeing. Such cultural differences should never be ignored, and underpins the importance of discussing fertility preservation in all men with cancer. It is not uncommon to see men in their 60’s undergoing treatment for prostate cancer developing depression and expressing treatment regret due to the resultant negative impact on their fertility potential ‘negating their role as a man’.
Unfortunately, fertility preservation in men remains an area of variable practice. A number of studies over the years have highlighted the low rate of knowledge and uptake of oncofertility planning. In 2002, Schover et al. reported that approximately 50% of oncologists discussed fertility preservation ...