Globally, advancing medical, surgical, and radiation treatment regimens for cancer therapy has improved survival rates, with further positive expectations in the subsequent years. As cancer treatment in the reproductive age group partakes in multiple medical and/or surgical treatments, cancer survivors often have diminished or absent reproductive capacities concerning the duration and cumulative dosing of treatment regimens [8].
The recent emphasis on fertility preservation for reproductive-age cancer patients undergoing treatment is to consider the physiological and emotional well-being and the ability of cancer survivors to reproduce offspring believed to enhance their quality of living after treatment [2].
Most of the oncologists in the current study have a positive attitude towards FP and were also knowledgeable about male and female fertility preservation, the correct timing of sending patients to do cryopreservation; most of them were familiar with oocyte cryopreservation, ovarian suppression, and embryonic cryopreservation and had a good perception regarding such topic; however, less than 50% of them discuss that subjects with their male patients, while only 25% discuss it with their female patient. This was reflected in the lower percentage of patient referrals to fertility preservation (22% − 27%).
One of the patient's rights is to discuss and receive complete fertility preservation information. Giving cancer patients enough information on reserving their fertility is possible in various ways.
According to a recent study by Ghaithi et al. conducted in Oman in 2023, oncologists' understanding of sperm cryopreservation (62%) and pretreatment with Gonadotrophin-releasing hormone (GnRH) agonists (47%), in particular, was high. On the other hand, only a small portion of participants (35.3%) and (27%, respectively) were aware of ovarian tissue and oocyte cryopreservation. However, the majority need more information about fertility preservation, particularly oocyte and ovarian cryopreservation. In the same context, oncologists in Oman asserted that sending patients to a reproductive specialist would significantly improve the patient's understanding of their fertility problems. They reported that they found, most frequently, patients had utilized sperm cryopreservation (34%) and pretreatment with GnRH agonist (38%) when questioned about how often they encountered cancer patients who had undergone various procedures for fertility preservation. However, the majority of medical professionals stated that they had never seen a cancer patient who had employed ovarian tissue cryopreservation (66%), testicular tissue cryopreservation (65%), in vitro fertilization with embryo cryopreservation (59%), or oocyte cryopreservation (59%) [9].
In the study of oncofertility care and influencing factors among cancer patients in Saudi Arabia in 2022, patients have adequate knowledge of fertility preservation, yet, oncologists occasionally referred such patients to a specific fertility facility, where only 17% have visited a fertility specialist and only 37.8% have received fertility counseling [5]. In the same context, less than half (47%) of oncologists in the USA study referred their patients to an infertility specialist [10], and only 1% of patients were directed to a center for assisted reproduction in the united kingdom study [11].
On the other hand, in a developing country (Mexico), 58% of the physicians always informed their patients about the jeopardy of infertility with cancer therapy, 38% continually discussed FP measures, and 52% always referred patients to fertility specialists [12].
The previous study conducted in Saudi Arabia in 2011 revealed poor knowledge about FP among oncologists, which in turn influenced their practice, where 41% of the physicians discuss fertility preservation with their patients, and less than 20% of them refer their patients to a specialist [7].
In comparison with the 2011 study, the possibility of preserving female fertility was unknown to 45% of oncologists; compared to the current study, where all physicians were familiar with many options for female fertility preservation, the most common one (77%) was oocyte cryopreservation, the difference was significant (P < 0.05). When questioned about referring patients to a reproductive specialist before starting therapy, nearly half the respondents in the previous study did not refer; compared to the current study, 28.9% did not refer (P = < 0.05). The percentage of the oncologists in both studies who did not know the sites for fertility preservation for men was nearly the same in both studies (32% VS 36.6%), which presents a significant deficit in their knowledge and information (most of our respondents 83.3%, did not know that sperm cryopreservation is available) and is reflected on their practices, as only a minor portion of young cancer patients have FP facilities. Among the reasons for the low percentage of referrals to fertility specialists was the oncologists' belief that the fertility preservation process is complicated and that their patients should start their treatment immediately without delay because of their critical status [7].
According to the Irish national study's findings, 87% of oncologists in the UK said they needed more information regarding FP alternatives. Most said they talked to patients about how treatments might affect their ability to conceive, but only 38% said they often gave them written information. A third said they did not ordinarily direct patients who had inquiries about fertility to a professional fertility service. Twenty-three percent had never read any FP guidelines. Lack of time, ignorance, perceived low success rates of FP alternatives, poor patient prognosis, and, to a lesser extent, whether the patient already had children, was single, or could not afford FP therapy were the main barriers to starting discussions about FP [13].
In our study, the most significant factors influencing the oncologist-patient discussion were the number of existing children (96.6%), marital status, cost, and type of cancer (76.7%, 65.7%, and 58.9 respectively). Having a patient who has a kid or children and is not concerned about future fertility is impacting their decision to start a discussion of FP with their patients, according to a study done in Oman in 2023, which indicated that more than half of the participants made this statement [9].
In agreement with the current study, the oncologists from the USA stated that the emergent need to start therapy was the leading cause of not discussing fertility preservation with their patients [14]. Notably, the same factors that influence the physician-patient discussion of FP in the current study were stated in the 2011 Saudi Arabia survey [7].
Reproduction is a vital topic between medical science and cultural values. Considering local and broader cultural contextual difficulties, it is crucial to pay more attention to how reproductive concerns are handled within the medical oncological practice, along with recommendations for young adult patients and family members of cancer patients involved in fertility and oncological care. Public health regulations that make preservation techniques available to everyone could address the limited access to fertility preservation.