Cancer is a leading cause of death in the female population, accounting for
6.7 million of new diagnoses worldwide. Cancer and its treatment can often impair the
chances of having children, and the fertility sparing issueis an emerging need. In fact,
more often, women are delaying conception and therefore, an increasing number of
women are diagnosed with malignancy before the desired completion of childbearing.
The care of these patients is challenging, and complex, and there is a total lack of
validated guidelines. The problem of fertility in a cancer patient encounters not only
clinical and technical problems, but it raises many other queries about ethical and
psychological perspectives. Since an international consensus statement should be
produced, the need for a dedicated multidisciplinary approach is mandatory to offer a
clinical range of treatment options. Cancer survivors and the medical community have
acknowledged the importance of patient counseling and the pursuit of options for
fertility preservation. In 2006, the American Society of Clinical Oncology published
the first recommendations on fertility preservation; however, despite the increasing
awareness regarding these recommendations, fertility preservation services are still
underutilized. ASCO guidelines advised oncologists to discuss fertility risks and
preservation strategies and make referrals to fertility specialists for interested patients
as early as possible.
There are some programmatic requirements to set up a fertility preservation service, the
most significant of which is the availability of a multidisciplinary medical team. A
treatment planning approach in which medical figures are experts in different
specialties aims to deliver a global treatment tailored to the patient and its disease. A
multidisciplinary approach to debating with fertility-sparing issue in oncological
patients has mainly two objectives: firstly, to ensure the oncological safety and, in
second place, the verification of the fertility preservation desire, that should be not only
the intention of the patient but also compliant to “minimum requirements” and
therefore a step-wise and careful selection of the women candidate to conservative
treatment is necessary. Counseling of patients pursuing fertility preservation should
include a discussion of all methods of fertility preservation as well as the alternatives.
Because of the sensitive and urgent nature of fertility preservation, a team approach to
patient counseling is recommended. Effective provision of fertility preservation options requires an ongoing collaborative
relationship among medical and surgical oncologists, reproductive endocrinologists and
other medical figures.
Oncologists have the initial responsibility to discuss the reproductive risks of intended
therapies with the patient and subsequently make referrals to experienced specialists to
discuss available reproductive options, which have to be discussed both for surgical
decisions and chemotherapy and/or radiotherapy administration. Multidisciplinary
teams should include: oncologists, gynecologic oncologists, radiation therapy
specialists, reproductive endocrinology and infertility specialists, andrologists, fertilitydedicated biologists, and nurses in the specialties of oncology and infertility, oncopsychologists and social workers. All of these are required to work together in order to
achieve a successful collaborative approach
Keywords: Cancer, Fertility, Multidisciplinary team
