Counselling is a requirement of the Human Fertilisation and Embryology Authority (HFEA), and is available within fertility departments in the UK. As counsellors working in reproductive medicine, we have different roles in order to satisfy the needs of individual patients during their devastating cancer journey.
The different types of counselling available to patients are: supportive fertility counselling, welfare-of-the child assessments, and finally, implications counselling for when patients are choosing gamete donation. This chapter will reveal through case examples the various dimensions of our counselling role, from patients’ diagnosis, through the fertility process to the aftermath.
Many feelings arise when a patient is faced with cancer. Their initial reaction is typically utter shock. They may feel frustration or guilt that their body has failed them, and sometimes question the lifestyle choices that may have contributed to their diagnosis. Oncologists and staff members are positioned to provide reassurance which can significantly ease their guilt. The patient is not only trying to come to terms with their diagnosis, but in addition is fast tracked through to fertility centres for an assessment to determine if egg or sperm freezing is possible. The latter is the easier option, but often male patients are too unwell or may produce a poor quality sample. Children or teenagers may simply be unable to produce a sperm sample. As an oncologist it may be tempting to present fertility preservation as a life-line of hope and possibilities, but the reality is that it is not always possible for patients to undertake fertility preservation. Fertility preservation is rarely straightforward, so we recommend oncologists ‘err on the side of caution’ so that in the long-term patients’ expectations are better managed.
The benefit of counselling is to explore if the patient wants to undergo fertility preservation. At this stage, they may not have the full extent of their prognosis as they often have not started treatment, therefore it is uncertain how they will respond to this. It may have been recommended by their oncologist, but sometimes patients may have not wanted to have children.
The Counsellor is also there to support the patient or couple when fertility preservation is not possible. In a sense they may experience a double trauma—they have to come to terms with their cancer as well as suffering the loss of their hoped-for future family.
Even when fertility preservation is possible, patients are confronted by the immediate intensity of appointments within two specialities: reproductive medicine and oncology. The IVF journey alone is psychologically and clinically demanding and time intensive. If they are in a relationship how do the couple feel about the fertility fertilization aspect; they may prefer to proceed promptly with cancer treatment rather than the preparation for egg collection or embryo freezing which involves regular scans, blood tests and an egg collection procedure. Often patients are ...