Although the incidence of cancers is on the rise globally, mortality has continued to decrease due to advances in early detection and treatment. Cancer treatments such as chemotherapy and radiotherapy can impact the reproductive capacity of survivors by inducing premature ovarian failure and subsequent infertility causing significant psychological distress with decreased quality of life. Despite the increasing need for fertility preservation services for the rising number of cancer survivors and the recent advances in assisted reproductive technology, many women with cancers in low, middle, and to a lesser extent, high-income countries have no access to these services. This article, therefore, presents an overview of the effect of cancer treatment on fertility, options of fertility preservation, and factors influencing fertility preservation utilization by women who had a cancer diagnosis. In addition, we discuss the availability, practices, and outcomes of fertility preservation services in low, middle, and high-income countries and highlight pragmatic steps to improving access to oncofertility care for women with cancers globally.
Cancer mortality is reducing globally creating a rise in cancer survivors with a huge need for fertility preservation.
- • Cancer treatments can impact the reproductive capacity of survivors by inducing premature ovarian failure.
- • Many women with cancers in low, middle, and high-income countries have no access to fertility preservation services.
- • Access to fertility preservation is determined by patients, oncology providers, socioeconomic, and institutional factors.
- • Addressing the unmet need of fertility preservation requires a collaborative effort of relevant stakeholders.
The incidence of cancers continues to rise globally with an estimated 19.3 million new cases in 2020 . Due to aging and growing populations with an increasing prevalence of risk factors, the global incidence of cancers is expected to continue to rise with a projected incidence of 28.4 million by 2040 . Women make up 49.6% of the world’s population and account for 9.2 million (47.7%) of the new cases of cancer in 2020 . An estimated 1 in 17 females under the age of 49 years is expected to develop invasive cancer .
With advances in early detection and treatment, cancer mortality has continued to decrease globally over the past two decades . On the other hand, cancer treatments such as chemotherapy and radiotherapy are often associated with many undesirable adverse events including an impact on the reproductive capacity of cancer survivors. Premature ovarian failure and subsequent infertility are established complications of these interventions, as a result, are of major concern to most women undergoing cancer treatment . The emotional toll of cancer diagnosis could be compounded by the fear of partial or complete loss of fertility leading to a reduction in quality of life . This risk of infertility depends on the type of cancer, age of the patient, type of treatment, fertility preservation window before initiation of cancer treatment, and risk of metastasis to the ovaries . Fertility preservation options such as oocyte and embryo cryopreservation and other evolving experimental treatments are available to women with cancers .
Despite the significance of fertility preservation in cancer care and the recent advances in assisted reproduction technologies, many women across the world are unaware of the availability of these services or have no access to them. This study, therefore, describes the options of fertility preservation, as well as availability and uptake in low, middle, and high-income countries. We also discuss factors influencing fertility preservation uptake and outline a pragmatic approach to address this unmet need of women with cancers who are facing the prospect of losing their fertility.