Effects of cancer treatment on reproductive functions: guidance on management

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Remarkable advances have taken place in the management of cancer in recent years, with a marked increase in cure rates. This rapid progress, though, has not been matched by a proper evaluation of the gonadal toxicity of the many drugs now in routine use.

This guidance, published in 2007 and written by a multidisciplinary expert group, sets out the effects of a range of cancer treatments on reproductive functions, and provides clear standards for management. Approximately 11,00 adults in the 15-40 age group are diagnosed with cancer each year, and for many of these younger cancer patients fertility is or will become extremely important. The report makes the care for comprehensive provision and funding of fertility services nationwide.

The working party stresses the need for full discussion with patients before their treatment about its possible effects on fertility, and provides clear patient information for men and women.

This guidance is essential reading for all clinicians, health professionals and clinical service managers involved in cancer care, fertility specialists, service commissioners and research funders. It will be useful to general practices, primary care trusts, government health advisors and cancer charities. The language used has made technical information as accessible as possible to cancer patients and their families.

'Members of the multidisciplinary expert working party are to be congratulated for their clear and comprehensive summary of the state of knowledge in this area and the implications for patient care within the NHS' Professor Mike Richards, National Cancer Director

Contents

  • Summary and recommendations
  • Reproductive physiology
  • Effects of cancer treatment on fertility
  • Breast cancer
  • Hodgkin and non-Hodgkin lymphoma
  • Testicular cancer
  • Cervical cancer
  • Sarcoma (osteosarcoma, Ewing's sarcoma and soft-tissue sarcoma)
  • Leukaemia
  • Recommended procedures before commencing chemotherapy/radiotherapy likely to affect fertility
  • Sperm storage
  • Testicular sperm extraction
  • Embryo storage
  • Management of post-treatment infertility
  • Artificial insemination by husband's/partner's cryopreserved semen
  • Donor insemination
  • IVF/ICSI
  • Alternative means of family increase
  • Surrogacy
  • Adoption
  • International adoption
  • Hormone replacement following gonadal damage
  • Cancer and pregnancy
  • Pregnancy and offspring after cancer treatment
  • Potential future directions for preservation of fertility
  • Patient information

 The guidance can be downloaded as a pdf.

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