[Skip to Content]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
[Skip to Content Landing]
Loren  AW, Mangu  PB, Beck  LN,  et al; American Society of Clinical Oncology.  Fertility preservation for patients with cancer: American Society of Clinical Oncology clinical practice guideline update.   J Clin Oncol. 2013;31(19):2500-2510. doi:10.1200/JCO.2013.49.2678 PubMedGoogle ScholarCrossref
Jeruss  JS, Woodruff  TK.  Preservation of fertility in patients with cancer.   N Engl J Med. 2009;360(9):902-911. doi:10.1056/NEJMra0801454 PubMedGoogle ScholarCrossref
Kim  S-Y, Kim  SK, Lee  JR, Woodruff  TK.  Toward precision medicine for preserving fertility in cancer patients: existing and emerging fertility preservation options for women.   J Gynecol Oncol. 2016;27(2):e22. doi:10.3802/jgo.2016.27.e22 PubMedGoogle Scholar
Ethics Committee of the American Society for Reproductive Medicine.  Fertility preservation and reproduction in cancer patients.   Fertil Steril. 2005;83(6):1622-1628. doi:10.1016/j.fertnstert.2005.03.013 PubMedGoogle ScholarCrossref
Lee  SJ, Schover  LR, Partridge  AH,  et al; American Society of Clinical Oncology.  American Society of Clinical Oncology recommendations on fertility preservation in cancer patients.   J Clin Oncol. 2006;24(18):2917-2931. doi:10.1200/JCO.2006.06.5888 PubMedGoogle ScholarCrossref
Neuss  MN, Malin  JL, Chan  S,  et al.  Measuring the improving quality of outpatient care in medical oncology practices in the United States.   J Clin Oncol. 2013;31(11):1471-1477. doi:10.1200/JCO.2012.43.3300 PubMedGoogle ScholarCrossref
Oktay  K, Harvey  BE, Partridge  AH,  et al.  Fertility preservation in patients with cancer: ASCO clinical practice guideline update.   J Clin Oncol. 2018;36(19):1994-2001. doi:10.1200/JCO.2018.78.1914 PubMedGoogle ScholarCrossref
Del-Pozo-Lérida  S, Salvador  C, Martínez-Soler  F, Tortosa  A, Perucho  M, Giménez-Bonafé  P.  Preservation of fertility in patients with cancer.   Oncol Rep. 2019;41(5):2607-2614.PubMedGoogle Scholar
von Elm  E, Altman  DG, Egger  M, Pocock  SJ, Gøtzsche  PC, Vandenbroucke  JP; STROBE Initiative.  The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.   J Clin Epidemiol. 2008;61(4):344-349. doi:10.1016/j.jclinepi.2007.11.008 PubMedGoogle ScholarCrossref
Alzahrani  Z.  QOPI certification roadmap.   J Glob Oncol. 2018;4:1-5.PubMedGoogle Scholar
ASCO QOPI Certification Program. Standards Manual. Published January 2020. Accessed February 23, 2020. https://practice.asco.org/sites/default/files/drupalfiles/2020-04/QOPI%20Certification%20Program%20Standards%20Manual%202020.pdf
Resolve: The National Infertility Association.  Infertility Coverage by State. Published 2020. Accessed February 22, 2020. http://Resolve.org/what-are-my-options/insurance-coverage/infertility-coverage-state/
Furui  T, Takai  Y, Kimura  F,  et al.  Fertility preservation in adolescent and young adult cancer patients: from a part of a national survey on oncofertility in Japan.   Reprod Med Biol. 2018;18(1):97-104. doi:10.1002/rmb2.12256 PubMedGoogle ScholarCrossref
Covelli  A, Facey  M, Kennedy  E,  et al.  Clinicians’ perspectives on barriers to discussing infertility and fertility preservation with young women with cancer.   JAMA Netw Open. 2019;2(11):e1914511. doi:10.1001/jamanetworkopen.2019.14511 PubMedGoogle Scholar
Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words
    Views 2,185
    Citations 0
    Original Investigation
    July 17, 2020

    Evaluation of Reported Fertility Preservation Counseling Before Chemotherapy Using the Quality Oncology Practice Initiative Survey

    Author Affiliations
    • 1Section of Urology, University of Manitoba, Winnipeg, Manitoba, Canada
    • 2The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
    • 3Department of Urology, University of Miami Miller School of Medicine, Miami, Florida
    • 4Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
    JAMA Netw Open. 2020;3(7):e2010806. doi:10.1001/jamanetworkopen.2020.10806
    Key Points español 中文 (chinese)

    Question  What factors were associated with discussions about fertility preservation before initiating chemotherapy and referrals to reproductive specialists among patients with recently diagnosed cancer?

    Findings  In this cross-sectional study of 6976 patients of reproductive age, 43.5% had a discussion with their clinician about the risk of infertility associated with chemotherapy; women were more likely to be counseled. Discussions of fertility preservation occurred at higher rates in academic centers compared with private practice settings, and mandated state laws for fertility preservation were associated with improved frequency of discussing fertility risks.

    Meaning  The findings suggest that the American Society of Clinical Oncology quality measures should be better disseminated for patients of reproductive age regarding discussion of infertility risk and fertility preservation and appropriate referral to fertility specialists before the onset of chemotherapy.


    Importance  The opportunity to discuss fertility preservation is essential for patients of reproductive age with newly diagnosed cancer before the initiation of treatment.

    Objective  To identify factors associated with fertility preservation counseling among patients of reproductive age before initiating chemotherapy.

    Design, Setting, and Participants  This cross-sectional study used data obtained from the American Society of Clinical Oncology (ASCO) Quality Oncology Practice Initiative, an oncologist-led quality assessment program that surveys approximately 400 oncology practices biannually, from January, 2015, to June, 2019.

    Main Outcomes and Measures  The primary outcome was whether reproductive risks were discussed before initiation of chemotherapy. Multivariate logistic regression was performed to identify factors associated with fertility preservation counseling, controlling for age, sex, race/ethnicity, cancer type, year of study, region, clinic type (academic vs private), annual clinic volume, and rates of insurance coverage.

    Results  Among the 6976 patients of reproductive age (3571 men [51%]; mean (SD) age, 42.5 [7.1] years), with reproductive age ranging from 18 to 40 years for 3405 women and from 18 to 50 years for 3571 men, clinics reported that 3036 of 6976 patients (44%) received counseling regarding the risk of infertility associated with chemotherapy. Women were more likely to be informed (1912 of 3405 [56%]) compared with men (1126 of 3571 [32%]) (P < .001). Factors associated with reduced likelihood of fertility risk discussion included male sex (odds ratio [OR], 0.73; 95% CI, 0.60-0.90), increasing age (OR, 0.93; 95% CI, 0.92-0.94), private practice setting (OR, 0.70; 95% CI, 0.53-0.93), and lack of multidisciplinary team planning (OR, 0.54; 95% CI, 0.41-0.70). Factors associated with increased likelihood of fertility risk discussion included having breast cancer (OR, 1.39; 95% CI, 1.12-1.73) and lymphatic or hematopoietic cancers (OR, 1.79; 95% CI, 1.33-2.40), participating in each subsequent study year (OR, 1.16; 95% CI, 1.08-1.24), receiving care in an academic clinic (OR, 1.45; 95% CI, 1.05-2.01), and being a practice offering clinical trial enrollment (OR, 1.60; 95% CI, 1.13-2.29). States with legislatively mandated coverage of fertility preservation had significantly higher rates of fertility risk discussion compared with states without legislation (48.6% vs 39.6%, P < .001).

    Conclusions and Relevance  The findings suggest that clinicians are more likely to counsel younger patients and female patients about reproductive risks before initiation of chemotherapy. State laws mandating fertility preservation coverage may be associated with improved frequency of fertility counseling before chemotherapy. Further awareness and implementation of ASCO guidelines appear to be needed to improve rates of fertility risk discussion and referrals to fertility specialists before chemotherapy.