Fertility and Cancer – Understanding the Issue and Options for Assisted Reproductive Technologies (ART)
By Naazish Shariff, MPH Graduate, School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa.
Hello readers! My name is Naazish and I am a recent Master of Public Health graduate from the University of Ottawa. Throughout my academic career, I have studied and tried to understand the vast number of issues surrounding the provision of healthcare within Canadian and International contexts. The last semester of my graduate degree allowed me to explore an area of particular interest: women’s health. I’m excited to share my findings and I hope it sheds light on an important, and unfortunately overlooked, area of women’s health.
What brought me to this topic?
I chose the topic of access barriers to assisted reproductive technologies (ART) specifically among female cancer patients due to a combination of personal and academic motivations. First and foremost, I have always been fascinated by the field of reproductive technologies and its potential to help individuals and couples overcome infertility challenges. The devastating impact of cancer on a person’s physical and emotional well-being, coupled with the potential loss of fertility, motivated me to delve deeper into understanding the barriers faced by female cancer patients when seeking assisted reproductive technologies. Moreover, as I conducted a rapid review, I came across various studies that highlighted the high prevalence of infertility among female cancer patients. These statistics reaffirmed the significance of my chosen topic and underscored the urgent need to address access barriers in this specific context. Lastly, I was also driven by the desire to shed light on the societal and personal factors that can impede or facilitate access to these reproductive technologies for female cancer patients, aiming to contribute to the improvement of their overall quality of life.
The work I did (for the capstone MPH)
I decided to conduct a rapid review to gain a comprehensive understanding of the existing knowledge and evidence related to this issue in a timely manner. This allowed me to efficiently review a wide range of relevant literature within a shorter timeframe compared to a traditional systematic review. Additionally, by conducting a rapid review, I aimed to provide a concise summary of the current evidence, identify any research gaps, and offer insights that could inform future research and interventions. The goal was to provide a valuable resource that could assist healthcare professionals, policymakers, and other stakeholders in addressing access barriers and improving the reproductive care and support available to female cancer patients.
Reality and risk of infertility
Data indicates that approximately 17.5% of reproductive-aged couples worldwide experience infertility (1). In Canada, specifically, 1 in 6 couples experience infertility (2).
Infertility can significantly impact mental health, quality of life, and various other aspects of an individual’s life (3,4). Negative emotions, including depression, anxiety, stress, and feelings of isolation, grief, and loss, can also result from infertility (3,4). The emotional burden of infertility can be particularly high for couples undergoing treatment, which can be expensive, time-consuming, and physically demanding (3,5). Moreover, infertility may lead to social isolation and difficulties with family and friends, as they lack understanding or are insensitive to the couple’s struggles (5). Finally, in some cultures infertility can be stigmatized, leading to discrimination, social exclusion, and cultural pressure to have children (6).
Cancer therapy’s impact on fertility
Data suggests that one-third of women globally will be diagnosed with cancer in their lifetime (7). In fact, the global incidence of cancer is continuing to increase. The World Health Organization’s International Agency for Research on Cancer has projected an almost 50% increase (48.8%) in cancer cases among females globally by 2040 (8). Specifically, among women of reproductive age, cancer diagnoses are projected to increase by 12.5% (8).
Cancer treatment can have an impact on fertility, particularly among men and women of reproductive age (9). Chemotherapy, radiation therapy, and surgery can damage or destroy reproductive cells, resulting in reduced or complete loss of fertility (9,10). The extent of the impact on fertility depends on several factors, including the type and stage of cancer, the type of treatment, and the individual’s age and overall health (10,11).
Resources available
There are many resources available to support and increase knowledge on fertility treatment for female cancer patients, I’ve listed and described a few key ones here:
- Oncofertility Programs: Many major cancer centers and hospitals have specialized oncofertility programs that focus on preserving fertility before cancer treatment. These programs offer comprehensive reproductive counseling, fertility preservation options (such as egg or embryo freezing), and coordination with oncologists to ensure safe and timely interventions.
- Insurance Coverage: Some insurance companies cover fertility preservation procedures for cancer patients. It’s important to check with your insurance provider to understand the specific coverage and requirements. Additionally, legislation in certain countries or states may mandate insurance coverage for fertility preservation in cancer patients.
- Support Organizations: Various support organizations provide information, emotional support, and resources for cancer patients seeking fertility treatment.
Importance
ART can offer cancer patients a way to preserve their fertility. For women, this can be supported by freezing eggs, embryos, or ovarian tissue prior to undergoing cancer treatment. For men, freezing and preserving sperm is an option. These supportive technologies can provide people with a chance to conceive and bear children in the future and help maintain their reproductive autonomy and quality of life (9,12).
Unfortunately, there currently exist many access barriers to ART services among the general population. Access barriers to ART disproportionately affect marginalized populations, including low-income individuals, racial and ethnic minorities, and LGBTQ+ individuals (13). Therefore, addressing these barriers is critical to promoting health equity and reducing health disparities.
When compared to literature on access barriers within general populations (not focused on cancer patients), it was indicated that healthcare providers play a vital role. This is because people who are diagnosed with cancer are typically not thinking about fertility preservation and therefore, rely on their healthcare provider on providing information.
Solutions
The intersection between cancer and ART (= oncofertility) is projected to become increasingly common throughout the next few decades. It is important to understand whether barriers exist that may hinder access to these services and minimize the negative ripple consequences which may arise as a result. These consequences include but are not limited to poor mental health and a decline in quality of life.
The results of this research will hopefully serve as a starting point for future research in this field. It is important to note that the results are solely based on the current literature, and not from the interactions between researchers and various stakeholders such as health care providers, hospital executives and patients. Therefore, the following recommendations are not advised to be implemented prior to the interactions. They are simply presented to highlight the importance of the results and the possible applications which may arise as a result.
First, it is essential that increased collaboration and communication between various health care providers, hospital executives and fertility clinics occur to help eliminate the role confusion faced by current health care providers.
Second, the implementation of training modules for both cancer and non-cancer specializing health care providers is also proposed to address current barriers. This will allow healthcare providers to improve their knowledge and ultimately provide a higher quality of care to their patients. As opposed to recommendations or guidelines, mandatory trainings may alleviate the issue of uninformed patients.
The resulting recommendations highlight the foundations of future projects which may help address the issue.
Additional next steps after this rapid review include talking with multiple stakeholders, such as patients, health care providers, and hospital executives to understand their viewpoint on the topic. This interaction may further strengthen the above recommendations and/or propose additional ways to address this current and emerging issue.
It is my hope that this blog has provided valuable insights into the challenges particularly faced by female cancer patients in accessing fertility treatments and highlighted the significance of addressing these barriers. If you have any questions, comments, or would like to continue the conversation further, please feel free to reach out to me at naazish.shariff@gmail.com or connect with me on LinkedIn. I look forward to engaging in meaningful discussions and collaborating to make a positive impact on women’s health. Thank you again for your time and interest.
References
1. Infertility Prevalence Estimates, 1990–2021 [Internet]. [cited 2023 Apr 18]. Available from: https://www.who.int/publications-detail-redirect/978920068315
2. Canada PHA of. Preconception health: health before pregnancy [Internet]. 2014 [cited 2023 Apr 18]. Available from: https://www.canada.ca/en/public-health/services/pregnancy/preconception-health-before.html
3. Ussher JM, Perz J. Infertility‐related distress following cancer for women and men: A mixed method study. Psycho‐Oncology. 2019 Mar;28(3):607–14.
4. Infertility [Internet]. [cited 2023 Apr 18]. Available from: https://www.who.int/health-topics/infertility
5. Tao P, Coates R, Maycock B. Investigating Marital Relationship in Infertility: A Systematic Review of Quantitative Studies. J Reprod Infertil. 2012;13(2):71–80.
6. Taebi M, Kariman N, Montazeri Ph.D.4 A, Majd HA. Infertility Stigma: A Qualitative Study on Feelings and Experiences of Infertile Women. Int J Fertil Steril. 2021;15(3):189–96.
7. Cancer [Internet]. [cited 2023 Apr 18]. Available from: https://www.who.int/news-room/fact-sheets/detail/cancer
8. Cancer Tomorrow [Internet]. [cited 2023 Apr 18]. Available from: https://gco.iarc.fr/tomorrow/en/dataviz/tables?types=0&sexes=2&mode=cancer&group_populations=1&multiple_populations=0&multiple_cancers=1&cancers=39&populations=900&age_start=3&age_end=9&years=2040
9. How Cancer and Cancer Treatment Can Affect Fertility in Females [Internet]. [cited 2023 Apr 18]. Available from: https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/fertility-and-sexual-side-effects/fertility-and-women-with-cancer/how-cancer-treatments-affect-fertility.html
10. Oncofertility in Canada: the impact of cancer on fertility – PMC [Internet]. [cited 2023 Apr 18]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3728062/
11. Female Fertility Issues and Cancer – Side Effects – NCI [Internet]. 2017 [cited 2023 Apr 18]. Available from: https://www.cancer.gov/about-cancer/treatment/side-effects/fertility-women
12. Lee S. Fertility problems [Internet]. Canadian Cancer Society. 2020 [cited 2023 Apr 18]. Available from: https://cancer.ca/en/treatments/side-effects/fertility-problems
13. Mackay A, Taylor S, Glass B. Inequity of Access: Scoping the Barriers to Assisted Reproductive Technologies. Pharmacy (Basel). 2023 Jan 16;11(1):17.