Letter to the Editor: A Call for Fertility Preservation Education for Medical Students

Dear Editor:

The current state for fertility preservation (FP) is not optimistic. As rightly pointed out in the article “Evaluation of Fertility Preservation Counseling and Treatments for Female Oncology Patients in an Urban Pediatric Canadian Center,” the FP counseling was unsatisfactory in Canadian pediatric female oncological patients. ¹ In total, 32.6% of patients received FP counseling before onset of treatment, and only 12 patients (13%) were referred to a reproductive specialist. In turn, one study reported that patients did not feel well supported, with many of them missing out on fertility care at crucial time. ² The common barriers of FP communicating include poor knowledge, cultural and religious limitations, and lack of communication skills. ³ Therefore, additional education to promote FP is highly needed.

In view of the immense cancer problem in China, we have conducted a pilot educational program on FP for Chinese medical students. This program consisted of a 90-minute presentation followed by a 20-minute visit to the FP center, and its contents covered the risk factors for fertility decline, FP technology, and challenges of FP in China. A total of 24 second- and third-year medical students with basic medical backgrounds participated in the study. All of them completed complete pre- and post-tests 30 minutes before and 2 days after the program, and participated in the follow-up interviews.

After education, students have established a knowledge system of FP, according to the significantly increased test score (p < 0.01). In the follow-up interview, students were equipped with the ability to simply offer FP counseling to patients, and spread FP knowledge to the public. Moreover, a majority of students recognized the feasibility and effectiveness of this program. Nearly 50% (n = 10) of them recommended learning FP during basic medical study, and 20.83% (n = 5) suggested starting FP studies as soon as possible.

The need of dedicated oncofertility programs has been recognized. In recent years, some oncology FPs have been established, such as the LIVESTRONG, which provided medical professionals with educational resources to improve doctor–patient communication. ⁴ In Australia, an FP toolkit that included educational materials has been created. ⁵ It greatly improved the quality of discussions and reduced the information barrier. In addition, educational interventions have been performed for faculty and advanced practice providers in America, Sweden, and Japan, which are all developed countries. Consistent with previous studies, the early findings in our study highlighted the potential benefits of an FP education in China.

A limitation of this study was the lack of quantitative evaluation indicators, such as clinical practice, communication strategies, and psychosocial support. Clarifying these aspects will help us further improve teaching programs. Besides, the sample size was small. In view of the efficiency of the educational program for medical students, more diverse and group-oriented educational programs should be carried out to not only health care providers but also patients and families.

The potential infertility was one of the major concerns of pediatric cancer survivors. Medical workers have the responsibility to address the possibility of infertility in a timely manner for these young women, and allow them to make well-informed decisions about their reproductive health.