Advanced practice nurses: Improving access to fertility preservation for oncology patients

Eleanor Hendershot, Anne-Marie Maloney, Sandy Fawcett, Sharmy Sarvanantham, Eileen McMahon, Abha Gupta, Laura Mitchell


Cancer therapies such as chemotherapy, radiation therapy and surgery may place the future fertility of both children and young adults at risk. Oncofertility is a rapidly evolving area that involves increasing access to fertility preservation (FP) information and services. This manuscript aims to: a) highlight the fertility risks associated with cancer therapy and its psychosocial impact, b) describe FP options, c) discuss the unique challenges of FP in distinct cancer populations, and d) illustrate the pivotal role of APNs in oncofertility counselling and education.

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American Society for Reproductive Medicine (ASRM). (2013a). Fertility preservation and reproduction in patients facing gonadotoxic therapies: A committee opinion. Fertil Steril, 100(5), 1224–1231. doi:10.1016/j.fertnstert.2013.08.041

American Society for Reproductive Medicine (ASRM). (2013b). Mature oocyte cryopreservation: A guideline. Fertil Steril, 99(1), 37–43. doi:10.1016/j.fertnstert.2012.09.028

Barton, S.E., Najita, J.S., Ginsburg, E.S., Leisenring, W.M., Stovall, M., Weathers, R.E., … Diller, L. (2013). Infertility, infertility treatment, and achievement of pregnancy in female survivors of childhood cancer: A report from the Childhood Cancer Survivor Study cohort. Lancet Oncol, 14(9), 873–881. doi:10.1016/s1470-2045(13)70251-1

Blumenfeld, Z. (2014). Fertility preservation and GnRHa for chemotherapy: Debate. Cancer Manag Res, 6, 313–315. doi:10.2147/cmar.s66600

Canadian Nurses Association (CNA). (2007). Position Paper. Advanced Nursing Practice. Ottawa, ON: Author.

Crawshaw, M. (2013). Psychosocial oncofertility issues faced by adolescents and young adults over their lifetime: A review of the research. Hum Fertil (Camb), 16(1), 59–63. doi:10.3109/14647273.2012.733480

Fernandez, C., Fraser, G.A., Freeman, C., Grunfeld, E., Gupta, A., Mery, L.S., … Schacter, B. (2011). Principles and recommendations for the provision of healthcare in Canada to adolescent and young adult-aged cancer patients and survivors. J Adolesc Young Adult Oncol, 1(1), 53–59. doi:10.1089/jayao.2010.0008

Fernbach, A., Lockart, B., Armus, C.L., Bashore, L.M., Levine, J., Kroon, L., … Rodgers, C. (2014). Evidence-based recommendations for rertility preservation options for inclusion in treatment protocols for pediatric and adolescent patients diagnosed with cancer. J Pediatr Oncol Nurs, 31(4), 211–222. doi:10.1177/1043454214532025

Ginsberg, J.P. (2011). Educational paper: The effect of cancer therapy on fertility, the assessment of fertility and fertility preservation options for pediatric patients. Eur J Pediatr, 170(6), 703–708. doi:10.1007/s00431-010-1359-4

Government of Canada (2004, March 29). Assisted human reproduction act. Retrieved from

Green, D.M., Sklar, C.A., Boice, J.D., Jr., Mulvihill, J.J., Whitton, J.A., Stovall, M., & Yasui, Y. (2009). Ovarian failure and reproductive outcomes after childhood cancer treatment: Results from the Childhood Cancer Survivor Study. J Clin Oncol, 27(14), 2374–2381. doi:10.1200/jco.2008.21.1839

Green, D.M., Whitton, J.A., Stovall, M., Mertens, A.C., Donaldson, S.S., Ruymann, F.B., … Robison, L.L. (2002). Pregnancy outcome of female survivors of childhood cancer: A report from the Childhood Cancer Survivor Study. Am J Obstet Gynecol, 187(4), 1070–1080.

Guerin, J.F. (2005). [Testicular tissue cryoconservation for prepubertal boy: indications and feasibility]. Gynecol Obstet Fertil, 33(10), 804–808. doi:10.1016/j.gyobfe.2005.07.033

Hospital., C. f. F. a. R. H. a. M. S. (2012). Price List.

Hsiao, W., Stahl, P.J., Osterberg, E.C., Nejat, E., Palermo, G.D., Rosenwaks, Z., & Schlegel, P.N. (2011). Successful treatment of postchemotherapy azoospermia with microsurgical testicular sperm extraction: The Weill Cornell experience. J Clin Oncol, 29(12), 1607–1611. doi:10.1200/jco.2010.33.7808

Johnson, M.D., Cooper, A.R., Jungheim, E.S., Lanzendorf, S.E., Odem, R.R., & Ratts, V.S. (2013). Sperm banking for fertility preservation: A 20-year experience. Eur J Obstet Gynecol Reprod Biol, 170(1), 177–182. doi:10.1016/j.ejogrb.2013.06.021

King, L., Quinn, G.P., Vadaparampil, S.T., Gwede, C.K., Miree, C.A., Wilson, C., … Perrin, K. (2008). Oncology nurses’ perceptions of barriers to discussion of fertility preservation with patients with cancer. Clin J Oncol Nurs, 12(3), 467–476. doi:10.1188/08.cjon.467-476

Knight, S., Lorenzo, A., Maloney, A.M., Srikanthan, A., Donen, R., Greenblatt, E., & Gupta, A. (2015). An approach to fertility preservation in prepubertal and postpubertal females: A critical review of current literature. Pediatr Blood Cancer, 62(6), 935–9. doi:10.1002/pbc.25440

Kort, J.D., Eisenberg, M.L., Millheiser, L.S., & Westphal, L.M. (2014). Fertility issues in cancer survivorship. CA Cancer J Clin, 64(2), 118–134. doi:10.3322/caac.21205

Levine, J., Canada, A., & Stern, C.J. (2010). Fertility preservation in adolescents and young adults with cancer. J Clin Oncol, 28(32), 4831–4841. doi:10.1200/jco.2009.22.8312

Loren, A.W., Mangu, P.B., Beck, L.N., Brennan, L., Magdalinski, A.J., Partridge, A.H., … Oktay, K., American Society of Clinical Oncology (ASCO). (2013). Fertility preservation for patients with cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol, 31(19), 2500-2510. doi: 10.1200/jco.2013.49.2678

Medicine, A. S. f. R. (2013a). Fertility preservation and reproduction in patients facing gonadotoxic therapies: a committee opinion. Fertil Steril, 100(5), 1224-1231. doi: 10.1016/j.fertnstert.2013.08.041

Medicine, A. S. f. R. (2013b). Mature oocyte cryopreservation: a guideline. Fertil Steril, 99(1), 37–43. doi: 10.1016/j.fertnstert.2012.09.028

Meistrich, M.L. (2013). Effects of chemotherapy and radiotherapy on spermatogenesis in humans. Fertil Steril, 100(5), 1180–1186. doi:10.1016/j.fertnstert.2013.08.010

Meistrich, M.L., & Byrne, J. (2002). Genetic disease in offspring of long-term survivors of childhood and adolescent cancer treated with potentially mutagenic therapies. Am J Hum Genet, 70(4), 1069–1071. doi:10.1086/339466

Nagel, K., & Neal, M. (2008). Discussions regarding sperm banking with adolescent and young adult males who have cancer. J Pediatr Oncol Nurs, 25(2), 102–106. doi:10.1177/1043454208314459

Nahata, L., Cohen, L.E., & Yu, R.N. (2012). Barriers to fertility preservation in male adolescents with cancer: It’s time for a multidisciplinary approach that includes urologists. Urology, 79(6), 1206–1209. doi:10.1016/j.urology.2012.02.035

National Cancer Institute (2015, May 15). Adolescents and young adults with cancer. Retrieved from

Ogle, S.K., Hobbie, W.L., Carlson, C.A., Meadows, A.T., Reilly, M.M., & Ginsberg, J.P. (2008). Sperm banking for adolescents with cancer. J Pediatr Oncol Nurs, 25(2), 97–101. doi:10.1177/1043454207311922

Roberts, J., Tallon, N., & Holzer, H. (2014). Canadian Fertility and Andrology Society (CFAS)

Rodriguez-Wallberg, K.A. (2012). Principles of cancer treatment: Impact on reproduction. Adv Exp Med Biol, 732, 1–8. doi: 0.1007/978-94-007-2492-1_1

Rodriguez-Wallberg, K.A., & Oktay, K. (2010). Fertility preservation medicine: options for young adults and children with cancer. J Pediatr Hematol Oncol, 32(5), 390–396. doi:10.1097/MPH.0b013e3181dce339

Rodriguez-Wallberg, K.A., & Oktay, K. (2014). Fertility preservation during cancer treatment: Clinical guidelines. Cancer Manag Res, 6, 105–117. doi:10.2147/cmar.s32380

Tschudin, S., & Bitzer, J. (2009). Psychological aspects of fertility preservation in men and women affected by cancer and other life-threatening diseases. Hum Reprod Update, 15(5), 587–597. doi:10.1093/humupd/dmp015

Vadaparampil, S.T., Hutchins, N.M., & Quinn, G.P. (2013). Reproductive health in the adolescent and young adult cancer patient: An innovative training program for oncology nurses. J Cancer Educ, 28(1), 197–208. doi:10.1007/s13187-012-0435-z

Wallace, W.H., Anderson, R.A., & Irvine, D.S. (2005). Fertility preservation for young patients with cancer: Who is at risk and what can be offered? Lancet Oncol, 6(4), 209–218. doi:10.1016/s1470-2045(05)70092-9

Wo, J.Y., & Viswanathan, A.N. (2009). Impact of radiotherapy on fertility, pregnancy, and neonatal outcomes in female cancer patients. Int J Radiat Oncol Biol Phys, 73(5), 1304–1312. doi:10.1016/j.ijrobp.2008.12.016

Wright, C.I., Coad, J., Morgan, S., Stark, D., & Cable, M. (2014). ‘Just in case’: the fertility information needs of teenagers and young adults with cancer. Eur J Cancer Care (Engl), 23(2), 189–198. doi:10.1111/ecc.12137

Yee, S., Buckett, W., Campbell, S., Yanofsky, R., & Barr, R.D. (2012). A national study of the provision of oncofertility services to female patients in Canada. J Obstet Gynaecol Can, 34(9), 849–858.


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