Oncology nurses have a unique relationship with their patients that may differ from that of physicians, said Lindsay Kroener, MD. This relationship means that often nurses may be the person a patient turns to with questions and concerns about fertility preservation vs their physicians.

“I think a lot of times, the physicians are coming in [and] they have a million [other] things going on,” she said in an interview with 

 “Sometimes the nurses have a little more time [with the patient].”

Kroener recently presented on the topic during the 

 Miami Breast Cancer Conference®. Her presentation, “Answering Your Patient’s Questions About Fertility,” outlined 

the scope of the fertility preservation in cancer

 and candidate considerations, and conversations surrounding pregnancy following cancer treatment.

Approximately 1 in 48 women younger than 40 years old receive an invasive cancer diagnosis, Kroener explained in her presentation.2 Moreover, as survival rates continue to improve, the question of posttreatment fertility strategies has become more relevant. Many women who survive cancer are unfortunately at an elevated risk of infertility, ovarian insufficiency, and adverse perinatal outcomes.

However, a variety of factors, including age, ovarian reserve, and cancer therapy type or dosage all result in differing degrees of infertility risk.

“It is really important for us, as health care providers, to address the possibility of infertility and discuss options for fertility preservation with reproductive aged patients,” Kroener noted in her presentation. “This is endorsed by many professional societies, including ASCO, National Comprehensive Cancer Network, the American Society for Reproductive Medicine, and the American Academy of Pediatrics. Addressing these issues are really considered to be a measure of quality care in oncologic care.”

However, ensuring the nurses are up-to-speed on fertility preservations is a good place to begin. For this reason, Kroener said she was happy to be included on the nursing track at this year’s conference.

“Even at our own institution, this is something that we really want the nursing staff to be informed [about, especially] because they are in such direct contact with the patient and [represent] a great sort of resource of information,” Kroener told 

 “I was happy to see this on that track.”

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As prognoses continue to improve, concerns about treatment-associated fertility risks are becoming more prevalent and are often a topic of discussion between patients and their nurses or nurse practitioners.

Nurses Can Lead Conversations on Fertility Preservation 

Today, embryo and oocyte cryopreservation are 2 mainstays of fertility preservation in the realm of breast cancer treatment, according to Lindsay Kroener, MD, an assistant clinical professor in the Department of OB/GYN at UCLA David Geffen School of Medicine.

Kroener recently discussed the topic during the 

, “Answering Your Patient’s Questions About Fertility,” outlined the scope of the fertility preservation in cancer, different treatment options and candidate considerations, and conversations surrounding pregnancy following cancer treatment. In an interview with 

Kroener highlighted how egg and embryo cryopreservation have evolved over the years to represent the most reliable options for patients.

“These treatments are not going to be for everyone. But in terms [of oncofertility], egg and embryo cryopreservation are the best options we have,” she said.

Specialists conduct ovarian stimulation by injecting gonadotropins (FSH/HMG) to stimulate growth in multiple ovarian follicles. These injections are delivered across 8 to 12 days and initiation usually begins on the second or third day of the menstrual cycle. During this time, patients are monitored every other day via an ultrasound and blood work.

When the follicles reach an appropriate size, they receive a trigger shot to induce egg maturation. About 35 to 36 hours later, the eggs are retrieved. This procedure typically occurs in the outpatient setting for about 15 to 20 minutes, and while the patient is under a conscience sedation.

In the case of oocyte cryopreservation, the retrieved eggs are examined microscopically, and the mature ones are cryopreserved. For embryo cryopreservation, oocytes are fertilized with partner sperm on the day they are retrieved and then maintained in a culture for 5 to 7 days. When blastocyst stage occurs (100 cells) the specimen is cryopreserved.

“Those eggs can either be cryopreserved right at that time, or they can be grown out into embryos (if there's sperm to fertilize those eggs),” explained Kroener. “One of the key things [to consider] is [that], as of 2012, cryopreservation is actually considered non-experimental and so it really offers a good option for our non-partnered patients [who no longer need] to say, ‘Hey, I [need to] go find donor sperm to make embryos.’”

Lindsay Kroener, MD, offers an overview of current fertility preservation options for patients about to undergo cancer therapy. 

Lindsay Kroener, MD

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