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Dittrich R, Kliesch S, Schüring A, Balcerek M, Baston-Büst DM, Beck R, Beckmann MW, Behringer K, Borgmann-Staudt A, Cremer W, Denzer C, Diemer T, Dorn A, Fehm T, Gaase R, Germeyer A, Geue K, Ghadjar P, Goeckenjan M, Götte M, Guth D, Hauffa BP, Hehr U, Hetzer F, Hirchenhain J, Hoffmann W, Hornemann B, Jantke A, Kentenich H, Kiesel L, Köhn FM, Korell M, Lax S, Liebenthron J, Lux M, Meißner J, Micke O, Nassar N, Nawroth F, Nordhoff V, Ochsendorf F, Oppelt PG, Pelz J, Rau B, Reisch N, Riesenbeck D, Schlatt S, Sender A, Schwab R, Siedentopf F, Thorn P, Wagner S, Wildt L, Wimberger P, Wischmann T, von Wolff M, Lotz L. Fertility Preservation for Patients with Malignant Disease. Guideline of the DGGG, DGU and DGRM (S2k-Level, AWMF Registry No. 015/082, November 2017) - Recommendations and Statements for Girls and Women. Geburtshilfe Frauenheilkd 2018; 78:567-584. [PMID: 29962516 PMCID: PMC6018069 DOI: 10.1055/a-0611-5549] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 04/15/2018] [Accepted: 04/17/2018] [Indexed: 12/17/2022] Open
Abstract
Aim
The aim of this official guideline published by the German Society of Gynecology and Obstetrics (DGGG) and coordinated with the German Society of Urology (DGU) and the German Society of Reproductive Medicine (DGRM) is to provide consensus-based recommendations, obtained by evaluating the relevant literature, on counseling and fertility preservation for prepubertal girls and boys as well as patients of reproductive age. Statements and recommendations for girls and women are presented below. Statements or recommendations for boys and men are not the focus of this guideline.
Methods
This S2k guideline was developed at the suggestion of the guideline commission of the DGGG, DGU and DGRM and represents the structured consensus of representative members from various professional associations (n = 40).
Recommendations
The guideline provides recommendations on counseling and fertility preservation for women and girls which take account of the patientʼs personal circumstances, the planned oncologic therapy and the individual risk profile as well as the preferred approach for selected tumor entities.
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Affiliation(s)
- Ralf Dittrich
- Frauenklinik, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Sabine Kliesch
- Centrum für Reproduktionsmedizin und Andrologie, Universitätsklinik Münster, Münster, Germany
| | | | - Magdalena Balcerek
- Pädiatrie mit Schwerpunkt Onkologie und Hämatologie, Charité Berlin, Berlin, Germany
| | | | | | - Matthias W Beckmann
- Frauenklinik, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | | | - Anja Borgmann-Staudt
- Pädiatrie mit Schwerpunkt Onkologie und Hämatologie, Charité Berlin, Berlin, Germany
| | | | - Christian Denzer
- Kinder- und Jugendmedizin, Universitätsklinikum Ulm, Ulm, Germany
| | - Thorsten Diemer
- Klinik und Poliklinik für Urologie, Kinderurologie und Andrologie, Universitätsklinikum Gießen, Gießen, Germany
| | - Almut Dorn
- Praxis für Gynäkologische Psychosomatik, Hamburg, Germany
| | - Tanja Fehm
- Frauenklinik, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Rüdiger Gaase
- Gemeinschaftspraxis für Frauenheilkunde, Worms, Germany
| | - Ariane Germeyer
- Frauenklinik, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Kristina Geue
- Medizinische Psychologie und Medizinische Soziologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Pirus Ghadjar
- Radioonkologie und Strahlentherapie, Charité Berlin, Berlin, Germany
| | | | - Martin Götte
- Frauenklinik, Universitätsklinikum Münster, Münster, Germany
| | - Dagmar Guth
- Praxis für Frauenheilkunde Plauen, Plauen, Germany
| | | | - Ute Hehr
- Zentrum für Humangenetik, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Franc Hetzer
- Chirurgisches Departement, Spital Linth, Uznach, Switzerland
| | - Jens Hirchenhain
- Frauenklinik, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | | | | | | | | | - Ludwig Kiesel
- Frauenklinik, Universitätsklinikum Dresden, Dresden, Germany
| | | | - Matthias Korell
- Frauenklinik, Johanna Etienne Klinikum Neuss, Neuss, Germany
| | - Sigurd Lax
- Institut für Pathologie, LKH Graz Süd-West, Graz, Austria
| | - Jana Liebenthron
- Gynäkologische Endokrinologie und Reproduktionsmedizin, Universitätsklinikum Bonn, Bonn, Germany
| | - Michael Lux
- Frauenklinik, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Julia Meißner
- Hämatologie, Onkologie und Rheumatologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Oliver Micke
- Strahlentherapie und Radioonkologie, Franziskus Hospital Bielefeld, Bielefeld, Germany
| | | | - Frank Nawroth
- Facharzt-Zentrum für Kinderwunsch, Pränatale Medizin, Endokrinologie und Osteologie, amedes MVZ Hamburg GmbH, Hamburg, Germany
| | - Verena Nordhoff
- Centrum für Reproduktionsmedizin und Andrologie, Universitätsklinik Münster, Münster, Germany
| | - Falk Ochsendorf
- Andrologie, Dermatologie, Venerologie und Allergologie, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Patricia G Oppelt
- Frauenklinik, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Jörg Pelz
- Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Beate Rau
- Onkologische Chirurgie, Charité Berlin, Berlin, Germany
| | - Nicole Reisch
- Endokrinologie, Universitätsklinikum München, München, Germany
| | | | - Stefan Schlatt
- Centrum für Reproduktionsmedizin und Andrologie, Universitätsklinik Münster, Münster, Germany
| | - Annekathrin Sender
- Medizinische Psychologie und Medizinische Soziologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Roxana Schwab
- Frauenklinik, Universitätsklinikum Mainz, Mainz, Germany
| | - Friederike Siedentopf
- Brustzentrum, Martin-Luther-Krankenhaus, Paul Gerhardt Diakonie, Berlin-Wilmersdorf, Germany
| | - Petra Thorn
- Praxis für psychosoziale Kinderwunschberatung, Paar- und Familientherapie, Mörfelden-Walldorf, Germany
| | | | - Ludwig Wildt
- Gynäkologische Endokrinologie und Reproduktionsmedizin, Universitätsklinikum Innsbruck, Innsbruck, Austria
| | | | - Tewes Wischmann
- Medizinische Psychologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Michael von Wolff
- Gynäkologische Endokrinologie und Reproduktionsmedizin, Universitäts-Spital Bern, Bern, Switzerland
| | - Laura Lotz
- Frauenklinik, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
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Vu JV, Llarena NC, Estevez SL, Moravek MB, Jeruss JS. Oncofertility program implementation increases access to fertility preservation options and assisted reproductive procedures for breast cancer patients. J Surg Oncol 2016; 115:116-121. [PMID: 27966219 DOI: 10.1002/jso.24418] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 08/02/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND OBJECTIVES Breast cancer treatment can cause premature ovarian failure, yet the majority of young cancer patients do not receive adequate education about treatment effects before initiating chemotherapy. We studied the impact of an oncofertility program on access to fertility preservation. METHODS An oncofertility program was initiated to foster collaboration between oncologists and reproductive endocrinologists, and to help increase access to fertility preservation. Documented conversations about fertility concerns, specialist referrals, appointments, and fertility preservation procedures were compared between breast cancer patients from 2004 to 2006, before oncofertility program initiation, and 2007-2012, after program initiation. The study included women <45, stages 0-III, diagnosed before (n = 278) and after (n = 515) program initiation. RESULTS Demographics for the cohorts were similar. Fertility discussions (P < 0.0001), patients interested in maintaining fertility at diagnosis (P = 0.0041), referrals to reproductive endocrinologists (P < 0.0001), appointments (P < 0.0001), and fertility preservation procedures (P < 0.0183) increased significantly after programmatic implementation. CONCLUSIONS An oncofertility program increased discussions about fertility preservation and access to assisted reproductive procedures. This program positively impacted compliance with national guidelines advising reproductive-age cancer patients to be offered fertility preservation counseling as an initial component of the multidisciplinary care plan. J. Surg. Oncol. 2017;115:116-121. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Joceline V Vu
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Natalia C Llarena
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Molly B Moravek
- Department of Obstetrics and Gynecology, University of Michigan Health Systems, Ann Arbor, Michigan
| | - Jacqueline S Jeruss
- Department of Surgery, University of Michigan, Ann Arbor, Michigan.,Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Trivers KF, Fink AK, Partridge AH, Oktay K, Ginsburg ES, Li C, Pollack LA. Estimates of young breast cancer survivors at risk for infertility in the U.S. Oncologist 2014; 19:814-22. [PMID: 24951610 PMCID: PMC4122477 DOI: 10.1634/theoncologist.2014-0016] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 05/15/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Standard treatments for breast cancer can impair fertility. It is unknown how many U.S. survivors are at risk for infertility. We estimated the population at risk for infertility secondary to treatment among reproductive-aged breast cancer survivors. METHODS We combined data from three sources: the National Program of Cancer Registries (NPCR) and Surveillance, Epidemiology, and End Results cancer registry data on incident breast cancers diagnosed in women aged 15-44 years between 2004 and 2006; treatment data from NPCR's 2004 Breast and Prostate Cancer Data Quality and Patterns of Care (PoC) study; and data on women's intentions to have children from the 2006-2010 National Survey of Family Growth (NSFG). RESULTS In the cancer registry data, an average of 20,308 women with breast cancer aged <45 years were diagnosed annually. Based on estimates from PoC data, almost all of these survivors (97%, 19,416 women) were hormone receptor positive or received chemotherapy and would be at risk for infertility. These women need information about the impact of treatments on fertility. Estimates based on NSFG data suggest approximately half of these survivors (9,569 women) might want children and could benefit from fertility counseling and fertility preservation. CONCLUSION Nearly all young breast cancer survivors in the U.S. are at risk for infertility. Physicians should discuss the potential impact of treatment on fertility. A smaller but sizeable number of at-risk survivors may be interested in having children. Given the magnitude of potential infertility and its quality-of-life implications, these survivors should have access to and potential coverage for fertility services.
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Affiliation(s)
- Katrina F Trivers
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA; ICF International, Rockville, Maryland, USA; Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Reproductive Medicine and Laboratory of Fertility Preservation and Molecular Reproduction, New York Medical College, Valhalla, New York, USA; Innovation Institute for Fertility Preservation, New York, New York, USA
| | - Aliza K Fink
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA; ICF International, Rockville, Maryland, USA; Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Reproductive Medicine and Laboratory of Fertility Preservation and Molecular Reproduction, New York Medical College, Valhalla, New York, USA; Innovation Institute for Fertility Preservation, New York, New York, USA
| | - Ann H Partridge
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA; ICF International, Rockville, Maryland, USA; Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Reproductive Medicine and Laboratory of Fertility Preservation and Molecular Reproduction, New York Medical College, Valhalla, New York, USA; Innovation Institute for Fertility Preservation, New York, New York, USA
| | - Kutluk Oktay
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA; ICF International, Rockville, Maryland, USA; Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Reproductive Medicine and Laboratory of Fertility Preservation and Molecular Reproduction, New York Medical College, Valhalla, New York, USA; Innovation Institute for Fertility Preservation, New York, New York, USA
| | - Elizabeth S Ginsburg
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA; ICF International, Rockville, Maryland, USA; Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Reproductive Medicine and Laboratory of Fertility Preservation and Molecular Reproduction, New York Medical College, Valhalla, New York, USA; Innovation Institute for Fertility Preservation, New York, New York, USA
| | - Chunyu Li
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA; ICF International, Rockville, Maryland, USA; Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Reproductive Medicine and Laboratory of Fertility Preservation and Molecular Reproduction, New York Medical College, Valhalla, New York, USA; Innovation Institute for Fertility Preservation, New York, New York, USA
| | - Lori A Pollack
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA; ICF International, Rockville, Maryland, USA; Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Reproductive Medicine and Laboratory of Fertility Preservation and Molecular Reproduction, New York Medical College, Valhalla, New York, USA; Innovation Institute for Fertility Preservation, New York, New York, USA
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