Fertility Preservation in Women Diagnosed with Cancer: Evidence, Intuition and Equity.

Increasing numbers of women are surviving cancer and expect to realise their full reproductive potential. However the impact of anti-cancer treatment with chemo and radiotherapy can compromise future fertility.  Advances in medicine now offer the chance of fertility preservation to many but there are significant variations in terms of access and effectiveness.  A number of hormonal and non-hormonal agents have been considered as potential options for protecting the ovaries from the effects of chemotherapy but conclusive clinical evidence regarding their effectiveness is awaited. Improvements in laboratory techniques over the last few decades have meant that embryo or oocyte cryopreservation is seen as a viable option for many women diagnosed with cancer.  A decision to go down this route needs to take into account a number of factors including personal circumstances, access, expectations, prognosis, impact on cancer treatment and current ovarian reserve. For optimal management, fertility preservation needs to be embedded within the cancer care pathway but there are many parts of the world where this is not the case. There is also some evidence that fertility preservation services are less easily accessible for women than for men.

This presentation will discuss the rationale behind fertility preservation in women, examine the evidence base for the different options and explore perceptions about future fertility in women diagnosed with cancer in the context of available services.