Multi-disciplinary Approach to Fertility Preservation
Michael S. Neal
Scientific Director, ONE Fertility, 3210 Harvester Rd. Burlington, Ontario www.onefertility.com
mneal@onefertility.com
Outline
• Assisted Conception Options
• A team approach
• Education and Awareness
• Discussion
Cancer and Fertility Crossroads
Increasing Cancer Survival Rates
(≥ 70% for pediatric oncology)
Increased emphasis on Quality of Life
Advances in Assisted Reproductive Technologies (ART) +
Greater need for Information and Understanding about Fertility Risks and Options
=
Assisted Conception Options
Male Cancer Survivor Female Cancer Survivor
A R T IUI, IVF, ICSI
IVM, FET Azospermic
Spermic
Normal Ovarian Function No Ovarian
Function
No conception (12 mths)
Spontaneous Conception Abnormal Sperm
Parameters
Normal Sperm Function No Banked
Sperm
Pre-treatment Cryopreserved
Sperm
Donor Sperm
No Sperm After Biopsy
Sperm Recovered Testicular Biopsy
Donor Oocytes
Frozen Oocytes
(Frozen Pre-treatment)
Frozen Embryos
(Created Pre-treatment)
No Oocytes
Ovarian Tissue Transplant
Multi-disciplinary Team Approach to Fertility Preservation
Nursing
Oncology Fertility
Research Fundamental
Questions
Male
•DNA fragmentation study.
•Germ cell regeneration.
Scientific Community New ideas and approaches
Medical Team
Cancer Patient
Risk Management
Legal, ethical., government regulations (AHR)
Patient Support
Family of their own in future
Parents
Oncologist REI Physician
ART Lab Female
•Developing reliable ooctye freezing technology
•Ovarian tissue cryopreservation.
•In vitro maturation of oocytes
Patient Centered Research
•Improved communication between patients and Allied Health Professionals
•Referrals
Quality of Care Research
•Sperm and oocyte banking brochures
•Referral algorithm
Social Fertilie Future Work
www.fertilefuture.ca
Nursing Help a Child
Smile
Only 17.8% (146/821) newly diagnosed
AYA cancer patients utilized sperm cryopreservation technology.
Neal et al., Cancer 2007
Awareness is the key to increased use of sperm banking for oncology purposes.
Awareness of
Fertility Preservation Options
Challenges and Ethical Considerations
Who initiates the discussion?
- physician, nurse, social worker Age of the patient influences:
- consent process
- who should come to the clinic
(Mom/Dad/Partner)Consent for future use:
- what if no current partner
Challenges
• survey of Oncology Nurses
• unprepared for discussions
• identified the need for staff and patient education Sperm Banking brochure
• resources about health literacy and patient education
• AYA male patients
Patient Education Resources
• Writing Health Information for Patients and Families
Education
• “Health literacy” is used to describe literacy in the context of health and health care.
• Def’n: the ability to access, understand, evaluate and
communicate information as a way to promote, maintain and improve health in a variety of settings across the life course.
• Best way to educate patients
A word about health literacy
• Clear communication is recommended to enhance health literacy
• A key communication strategy is to use “plain language” when speaking to and writing for patients and families
• Plain language is a way of organizing and presenting
information so that it makes sense and is easy to read for the intended audience
Plain language
Conclusions
• Cancer treatment can have a devastating effect on the reproductive system
• Awareness and Education is required for not only patients, but, allied health care professionals.
• Oncologists combined with a multi-disciplinary team of health professionals provides hope for the future fertility of oncology patients.
Discussion
Michael S. Neal
ONE Fertility, and Reproductive Biology Division, Department of Obstetrics and Gynecology McMaster University, Hamilton, Ontario, Canada
mneal@onefertility.com
