Fertility focus: breaking the taboo
The importance of normalising conversations about fertility with the 2,500 young people who are diagnosed with cancer.
The importance of nurses normalising conversations about fertility when talking with young people who are diagnosed with cancer.
In the UK, around 2,500 young people are diagnosed with cancer each year and around 15% of them have a high risk of future fertility problems. Their specialist needs and support in terms of fertility are often overlooked.
Young people who are being treated for cancer will often require chemotherapy, radiotherapy or surgery, and sometimes a mix of all three. Once this level of intensive treatment has started, there is little that can be done to minimise any effects on fertility. It is therefore essential that preservation procedures are discussed and undertaken before treatment begins to give every young person the best future chances of fertility.
For young males, it is now common practice at most centres to refer them to the local conception unit for semen storage prior to any treatment; this should be offered at every cancer centre as it is universally available in UK. The collected sperm is then kept in frozen storage until needed.
The process for young females is not as simple – in the past, procedures for storing samples have been limited, experimental and generally not successful. In recent years, there have been huge advances in aiding reproduction and other options are now widely available at specialist centres, such as ovarian cryopreservation, ovarian stimulation and oocyte cryopreservation. However, these procedures can take anywhere from ten to 14 days to stimulate egg production, which may not be possible at a time when imminent treatment is crucial.
'It is essential that nurses are fully aware of all options available to young people and keep up to date with the latest research and developments'
Ovarian and testicular cryopreservation is increasingly available in paediatric cancer centres across the UK for patients as young as one year old, but is still in the experimental stages. It is currently not a commissioned NHS service so relies heavily on charitable funding.
It is essential that nurses are fully aware of all options available to young people and keep up to date with the latest research and developments. For some young people, the question of future fertility will be of utmost importance when they are diagnosed, yet others may not even think about having a family at this age. Therefore, we need to gauge their feelings and be mindful of how such conversations should be structured, while remaining open and honest.
The pathway for fertility preservation is difficult for young people and can be a lot to take in at a difficult time. They are already making choices about treatment, coming to terms with a cancer diagnosis, and then are being asked about fertility preferences.
Nurses are in a good position to champion fertility preservation
The consent process is lengthy and full of legal jargon, so it is important for nurses to guide them through it. Attending these appointments can be helpful, as well as keeping in regular contact with the young person, should they have any questions. Nurses are in a good position to champion fertility preservation in cancer services, and should do so wherever possible.
Fertility can be a taboo subject. As professionals, we need to normalise these conversations and embed them into our everyday practice. It is vital to acknowledge patients’ faith and beliefs. It may also be helpful to talk to young people without their parents about difficult subjects, such as fertility. Nurses need to ensure that young people feel safe and that their views are respected while helping them to determine the best fertility preservation route for them.
About the author
Sue Morgan is a nurse consultant at Leeds Teaching Hospitals NHS Trust and trustee of the charity Teenagers and Young Adults with Cancer (with advice from Dr Dan Yeomanson, consultant oncologist at Sheffield Children’s NHS Foundation Trust)