I recently had to discuss fertility with a 29yo Stage IV breast cancer patient, who at presentation 2 years ago had wide spread disease. She had visited with a fertility clinic who offered her IVF. She was requesting our medical release for her to get pregnant. To what degree are these fertility clinics responsible for potential causing harm to a Stage IV cancer patient? It was very up setting to see that a clinic was willing to take her on knowing they would likely lead to her early demise as she would have to be off treatment and be in an immunocompromised state during pregnancy. Have any of you come across this?
I have not had experience with a case like this, but do find it is an interesting issue to discuss! Do you feel the patient was well-educated about the risks/benefits for undergoing IVF and becoming pregnant, including impact to cancer treatment and prognosis? Is the fertility clinic affiliated with your hospital system? It seems it would be critically important to educate those providers about unique considerations of fertility in the context of advanced cancer, if you find that is lacking. If the patient was well-educated, provided truly informed consent, and based on their goals and values decided pregnancy/child rearing was most important (over longevity, for example), I do feel it is important to respect their wishes.
I’ve been in a visit with the oncologist, patient and family where education was provided but pt stressed the importance of this opportunity to complete fertility preservation despite the risks. I had a patient express to me the importance of the medical team acknowledging how important having a family was for her and her husband. She said it also allowed her to feel that her input was still important and all control was not being taken away.