Beyond fertility preservation: role of the oncofertility unit in the reproductive and gynecological follow-up of young cancer patients
Authors: Massarotti Claudia , Scaruffi Paola , Lambertini Matteo , Sozzi Fausta , Remorgida Valentino , Anserini Paola 
Published: June 2019

Abstract

STUDY QUESTION
Are there reasons that motivate young cancer survivors to ask for follow-up visits at an oncofertility unit?

SUMMARY ANSWER
Cancer survivors request oncofertility follow-up visits for the management of treatment-related side effects or ovarian reserve evaluation, even if not (or not yet) wishing for a pregnancy.

WHAT IS KNOWN ALREADY
Personalised oncofertility counselling before gonadotoxic therapies is considered standard of care for young women with newly diagnosed cancer. However, the long-term follow-up of these patients in an oncofertility unit is not described in the literature other than for the use of cryopreserved material.

STUDY DESIGN, SIZE, DURATION
We retrospectively examined rates and reasons for the first follow-up visits of 154 consecutive young female cancer patients (age range: 18–40 years) who underwent a pre-treatment consultation between January 2012 and June 2017. Demographic and clinical data were collected, as well as information about the chosen fertility preservation method, if any.

PARTICIPANTS/MATERIALS, SETTING, METHODS
Rates and reasons for follow-up visits were collected and expressed as percentages. Different reasons were examined in the whole cohort and stratified for type of malignancy. Possible predictive factors for return to the follow-up visit (age, nulliparity, presence of a partner, neoplasm, having cryopreserved material) were investigated through logistic regression.

MAIN RESULTS AND THE ROLE OF CHANCE
Out of 154 patients, 74 returned to the oncofertility unit (48.1%) for a follow-up visit. The first visit was requested mostly at the end of anticancer therapies (51.3% versus 40.5% during therapies and 8.1% after cancer relapse). Among these patients, only 10.8% returned for the first time because they were actively desiring a pregnancy. For the others, the most common reasons for consultations were management of gynecological adverse effects of therapies (29.7%) and evaluation of ovarian reserve not linked to an immediate desire for a pregnancy (39.2%). Other patients asked for contraception (4.1%), menopause counselling (5.4%), or new fertility preservation counselling because of cancer relapse (10.8%). None of the examined factors were significantly predictive of return to the oncofertility unit.

LIMITATIONS, REASONS FOR CAUTION
These findings represent the experience of a single centre. A longer duration of follow-up would be needed to provide more precise information on this regard.

WIDER IMPLICATION OF THE FINDINGS
The role of an oncofertility unit should not be limited to proposing fertility preservation procedures. In the management of young adult cancer patients, the reproductive medical specialist should be considered a key figure not only before but also during and after anticancer treatments to explore salient aspects of gynecological and reproductive health.

STUDY FUNDING/COMPETING INTEREST(S)
This research did not receive any specific funding. M.L. served as a consultant for Teva and received honoraria from Theramex outside the submitted work. The other authors declare no conflict of interest.

TRIAL REGISTRATION NUMBER
N.A.