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Introduction
Modern cancer therapies have led to increasing survival for young women with cancer (1). Many of these treatments can lead to detrimental impact on a woman's fertility, such as alkylating agents and radiation therapy (1,2). As more young women with cancer survive, issues such as fertility preservation increase in importance. This is evident from the number of publications and guidelines that have been recently published (2–6). Despite these recommendations, the provision of fertility preservation remains low (7,8). Lack of health care provider knowledge has been documented as a possible reason for lack of fertility preservation discussions and referrals.
The purpose of this guideline is to provide oncology healthcare providers with practical information about fertility preservation (FP) for post-pubescent female cancer patients. This work was undertaken at the Princess Margaret Cancer Center (PM) in Toronto, Canada, a large adult academic cancer centre, to provide a practical resource to health care providers in busy oncology clinics. This document is organized based on common topics that arise during acute treatment oncology care. The target readership for this guideline are physicians, nurse practitioners, nurses, pharmacists and social workers involved in cancer care delivery.
Data collection methods
A systematic literature review of published literature from January 2000 to June 2014 was completed using MEDLINE with search items: fertility preservation and cancer, cancer and female fertility, and fertility preservation and reviews. The most recent international oncology guidelines regarding FP in female cancer patients were also identified for which these practical guidelines were drafted upon. All recommendations were drawn from the literature search, with the available evidence provided to reviewing content experts. Once completed, eight subspecialty content experts at PM critiqued and reviewed the guidelines, to ensure agreement. After the initial review, revisions were made and recirculated to the content experts for final review and endorsement. Recommendations in this guideline are graded as per the GRADE system (Grading of Recommendations, Assessment, Development and Evaluation) (9). In GRADE, grades have two components: a two-level representation of the strength of recommendation (strong or weak) and a four-level representation of the quality of the evidence (high, moderate, low, and very low).
Results
Infertility defined
The two major categories of infertility relating to cancer treatment include acute ovarian failure (AOF) and premature (or primary) ovarian...