College Students' Perspectives Regarding Fertility Preservation

Introduction Literature Review Method Results Discussion Conclusion References Objective‐The purpose of this research is to examine college students' attitudes and knowledge of fertility preservation for cancer patients. The specific hypotheses were that students would have low levels of knowledge about the effects of chemotherapy on fertility and that religion would play a key role in their decision to accept fertility preservation if they had a cancer diagnosis. Method‐ A sample of 239 students from upper‐level classes at the University of South Florida was surveyed in order to assess knowledge and attitudes of college students. The survey consisted of questions derived from a survey administered at the 2007, “Facing Our Risk of Cancer Empowered” (FORCE) conference, and additional specific questions regarding cancer and fertility preservation aimed at general audience. Result‐In the case of a cancer diagnosis, 77.4% of students disagreed that religion would play the most important role, in their decision to accept fertility preservation. Most College Students' Perspectives Regarding Fertility Preservation http://www.lurj. org/article.php/vol4n2/fertility.xml 1 of 12 5/6/2010 11:47 AM students (43.5%) agree that their partner would play a more important role than religion. In their decision to accept or reject fertility preservation, and 33.1% of them strongly agreed high percentage of the students (75.3%) knew that chemotherapy caused sterility. Conclusion‐The data reinforce that patients from all educational level from all religious and ethnic backgrounds should be informed about the damages chemotherapy can cause and the fertility preservation options available to them depending on their age and gender At any age, a cancer diagnosis is devastating. It is devastating not only to the patient, but also to the patient's family members and friends. Chemotherapy offers hope, especially when the cancer is detected early. Because chemotherapy offers hope, the number of cancer survivors in all age groups is augmenting. Fertility preservation is of importance only to the patients in or below the reproductive age. When any patient is diagnosed with cancer, the greatest concern is survival, but for patients in reproductive age, the ability to become a biological parent is a secondary concern. It is not always considered so at the time of diagnosis and treatment, but after a successful treatment, it becomes very much so. Many patients diagnosed in their reproductive age manifest the desire to become biological parents after their treatment. However, many of them were not offered fertility preservation options before they went through chemotherapy. The number of young cancer survivors is increasing; therefore, the problem becomes more pronounced. As the cancer survivors see their treatment in retrospect, they remember that their oncologist did not inform them of the effects of chemotherapy on their reproductive system and about the fertility preservation options available to them. This research examines college students' attitudes and knowledge regarding fertility preservation for cancer patients. The primary hypotheses were that students would have low levels of awareness about the effects of chemotherapy on fertility and that a students' religion would play the most important role in his or her choice to accept or reject fertility preservation. The secondary hypotheses were that having a relative with cancer or speaking English as a primary language would impact knowledge and attitude regarding fertility preservation. Chemotherapy can affect fertility, but cancer itself can have a negative impact on fertility. Abnormal sperms and reduced sperm production have been found in men with untreated Hodgkin lymphoma and testicular cancer (Shin, Lo, & Lipshultz, 2005). Damage of the reproductive system leading to infertility in both gender is caused by several factors such as the type of drug and the dosage, the patients' reproductive status, the radiation location and College Students' Perspectives Regarding Fertility Preservation http://www.lurj. org/article.php/vol4n2/fertility.xml 2 of 12 5/6/2010 11:47 AM dosage, the patients' pubertal status and the patients' pre‐treatment fertility (Bahadur et al., 2006). Effects of chemotherapy on men The main injuries caused by chemotherapy in men are reduction of sperm production, poor sperm quality and motility, and DNA damage, which can be caused by either chemotherapy or radiation. Infertility caused by Chemotherapy can be temporary or permanent. Because chemotherapy has an effect on cells that are dividing uncontrollably, it can cause a lack of development in the germinal cells located in the seminiferous tubules; this may lead to reduced sperm production. When treatment is completed, male gonads take time to recover their function. The probability that they will recover their function depends on the male's age and the dosage of the chemotherapeutic agent. The time it takes for spermatogenesis to resume its function in some men seems to be dependent on the dosage level. The treatment agents used in combination appear to have an increased impact on fertility (Bahadur et al., 2006). Effects of chemotherapy on women Unlike in men, chemotherapy can damage many reproductive organs in women; these organs include the cervix, the uterus, the fallopian tubes and the ovaries. However, cancer, by itself, does not negatively impact women's fertility. While chemotherapy itself can affect these organs, their surgical removal due to can will certainly lead to infertility (Bahadur et al., 2006). Menopause resulting from chemotherapy may be caused by direct injury to the ovaries or indirect injury causing detriment of follicular cells. chemotherapy can also accelerate menopause (Lee et al., 2006). Chemotherapy can cause immediate sterility and premature menopause in women; it can damage the uterus and cervix, leading to inability to become pregnant or carry a baby (Bahadur et al., 2006). Temporary or permanent premature ovarian failure can result from chemotherapy. Chemotherapy can also cause ovarian fibrosis, which leads to failure of ovulation, absence of periods or irregular periods, and ultimately infertility. Age plays an important role in the effects chemotherapy has on the ovaries. Younger women's ovaries tend to be less affected than those of older women. The probability that the menstruation will resume depends on the drug, the dosage, and the woman's age. The probability that menstruation will return in women younger than 40 years of age is greater than that of women older than 40 years of age. When a combination of drug is used, there is less chance that menstruation will resume (Lee et al., 2006). Fertility preservation options for men Many fertility preservation options are available to men; the option chosen depends on the College Students' Perspectives Regarding Fertility Preservation http://www.lurj. org/article.php/vol4n2/fertility.xml 3 of 12 5/6/2010 11:47 AM man's age. Some options that may be ideal for men before puberty may not be so for men after puberty. Sperm banking is one of the most reliable fertility preservation options. Sperms are assessed, frozen and stored. This option is ideal for men after puberty. Another option is testicular tissue freezing, which is the surgical removal of the stem cells that produce sperms. The tissue is evaluated, frozen, and stored. This option is practical for men after puberty. Both sperm banking and testicular tissue freezing are practical options before chemotherapy. Testicular sperm extraction is practical for patients who are not producing sperm after treatment. The testicular tissue is removed and analyzed for remaining sperm cells. Any sperm found is used for in vitro fertilization (Singh, Davies, & Chatterjee, 2005). Radiation shielding of gonads is an option that can be used by men both before and after puberty. The gonads are shielded during treatment to reduce the radiation dosage to the testes (Bahadur et al., 2006). Other options are available for survivors that cannot be biological parents; these options are donor sperm, donor embryos, and adoption (Singh et al., 2005). Fertility preservation options for women There are even more fertility preservation options for women than men. Egg freezing is an ideal option for women before and after treatment. Eggs are removed, frozen, and stored. Ovarian tissue freezing is an option available to women before and after treatment. Ovaries are removed, frozen, and then transplanted after the treatment. In ovarian transposition, the ovaries are surgically transposed to reduce their exposure and damage that can result from chemotherapy and radiation. They must be transposed before treatment. Radical trachelectomy is an option used mainly by cervical cancer patients. It is the surgical removal of the cervix and the preservation of the uterus. During treatment, ovarian suppression by gonadotropin‐releasing hormones (GnRH) is another way of protecting the ovaries from damages that can result from chemotherapy and radiation. One of the most successful options is embryo freezing. Eggs are fertilized outside of the body and frozen (Sing et al., 2005). Radiation shielding of gonads is also available to women. Reproductive organs are shielded from exposure and damage of chemotherapy and radiation. Donor eggs, donor embryos, gestational surrogacy, and adoption are other options that survivors can consider (Bahadur et al., 2006). Complications in Pregnancy Despite the increasing number of fertility preservation options available to cancer patients before and after treatment, there is no guarantee that the patient will become a biological parent. The probability of getting pregnant is not 1 (one) in any of the options. Even if pregnancy results, the chance of complications is high. In cancer survivors, there is a greater probability of low birth weight, premature infants and miscarriages. Depending on t