3.6.2 Fertility preservation and contraception

Cancer and cancer treatment may cause fertility problems. This will depend on the age of the patient, the type of cancer and the treatment received. Infertility can range from difficulty having a child to the inability to have a child. Infertility after treatment may be temporary, lasting months to years, or permanent (AYA Cancer Fertility Preservation Guidance Working Group 2014).

Although MM usually occurs in elderly patients, around 2 per cent of patients are diagnosed below the age of 40 years. Patients of child-bearing potential need to be advised, and potentially referred, for a discussion about fertility preservation before starting treatment and need advice about contraception before, during and after treatment. Effective contraception is particularly important for those taking immunomodulators (IMiDs) such as thalidomide, lenalidomide and pomalidomide because these can cause serious birth defects and abnormalities to the fetus. Males should not conceive or donate sperm while taking IMiDs, and women should not become pregnant while taking them.

Patients and their family should be aware of the ongoing costs involved in optimising fertility. Fertility management may apply in both men and women. Fertility preservation options are different for men and women and the need for ongoing contraception applies to both men and women.

The potential for impaired fertility should be discussed and reinforced at different time points as appropriate throughout the diagnosis, treatment, surveillance and survivorship phases of care. These ongoing discussions will enable the patient and, if applicable, the family to make informed decisions. All discussions should be documented in the patient’s medical record.

More information

See the Cancer Council website  for more information.