When is "doing nothing" the right fertility preservation option?

One of the options that is sometimes forgotten about in conversations regarding fertility preservation is the option of not engaging in an active strategy for fertility preservation; in short, doing nothing. This option is selected by patients, for example, who have been counseled that it is unlikely that they will suffer much with respect to their fertility from the treatment that they‘re about to have.

Other common circumstances where patients will decline therapy is if they are concerned about the potential impact of, for example, the drugs that are used for emergency in vitro fertilization or for egg freezing on their cancers, and this is most commonly an issue for patients with breast cancer.

Specifically, during the period of time when the ovaries are stimulated, leading to an egg harvest—whether for egg freezing or for embryo freezing—the patient’s estrogen levels increase substantially and are elevated for a number of days. There are some physicians who think this is an unwise strategy to carry out in patients who have breast cancer, although the evidence that this is the case is still lacking. So, patients in this category may also often choose not to employ fertility preservation strategy. These patients are, on the other hand, very good candidates for tissue preservation if their principle concern is the effect the hormone changes on their cancer.

It’s important to recognize that the patients that are going through this process are under an enormous amount of stress. They have very recently discovered that they have a life-threatening illness and are required to make decisions about fertility preservation in very short time frames. It is not unusual when patients are under this kind of pressure and in particular when they have a strong desire to focus all of their emotional energy into the principal concern, which is to be cured of their disease, that they may choose to pass on fertility preservation options.