|Nalini Kaul Mahajan, Madhuri Patil, Padma Rekha Jirge
Aim: Objective of this document is to provide guidance to health care professionals on fertility preservation (FP) for Indian patients undergoing cancer treatment.
Participants: Extensive deliberations, discussion and brain storming was done with different reproductive medicine (RM) specialists, medical, radiation, surgical, gynaecological and oncologists and haematologists to develop the recommendations.
Evidence: A systematic review of the literature published up to December 2020 was carried out using PubMed and Cochrane Collaboration Library. International guidelines, cohort studies, case series, observational studies and randomized controlled trials currently available in literature were reviewed. Supplemental searches were made for individual conditions like lymphoma, leukaemia, haematological conditions, breast cancer, gynaecological cancers, immune disorders. Indian data on fertility preservation was limited to case series, hence opinion of experts was taken into account for the recommendations on fertility preservation in India. Cancer incidence and survival rates were taken from the Indian cancer registry (ICR). A panel of RM specialists across India reviewed the evidence and offered recommendations for Indian patients.
Process: Meetings were held with leading oncologists from major cancer institutes in India – Delhi: AIIMS, Medanta, Indraprastha Apollo hospital, Max SS hospital, Mumbai: Bombay Hospital; Miraj: Siddhivinayak hospital; Kolkata: Tata Medical Centre; Bangalore: Mazumdar Shaw Cancer Centre; Narayana Health City and HCG; The working group for the recommendation committee included members from the Fertility Preservation Society (India) and participating oncology experts.
Conclusions: The Fertility Preservation Society (India) recommends that oncologists should discuss the risk of infertility resulting from cancer treatment with patients of reproductive age group, at the earliest opportunity and provide initial information regarding the availability of FP. Patients with a good oncological prognosis at risk of infertility and interested in preservation of their fertility, should be referred to a reproductive medicine expert as early as possible after confirmatory diagnosis. Details of FP procedures including risks and subsequent reproductive outcome should be explained in detail by the reproductive medicine specialist. Genetic and social counselling should be made available to the patient to aid in taking an informed decision. Limiting factors in India include lack of awareness of FP options and availability, cost, lack of insurance coverage, experimental nature of some FP procedures.