Sonu Balhara: Discussing Fertility with Every Young Patient Before Starting Potentially Gonadotoxic Treatment

Sonu Balhara, Director of ART Fertility Clinic India, shared on LinkedIn:

“Fertility preservation is a subject very close to my heart.

I recently encountered a young man who, before beginning chemotherapy and radiotherapy for a brain tumour, had specifically asked whether he should preserve his semen. He was reassured that his fertility would not be affected and that sperm cryopreservation was unnecessary.

After completing treatment, he developed testicular failure. Unfortunately, the opportunity to preserve his fertility before treatment had already been lost.

This case has stayed with me because the outcome may have been different if he had received timely counselling and referral.

Cancer itself, chemotherapy, radiotherapy, bone-marrow transplantation and certain surgical procedures can temporarily or permanently impair fertility. Similarly, severe endometriosis, ovarian or testicular tumours and other medical conditions may compromise future reproductive potential.

I sincerely request all oncologists, radiation oncologists, haematologists, bone-marrow transplant physicians, breast surgeons and gynaecologists:

Please discuss fertility with every young patient before starting potentially gonadotoxic treatment – and refer them to a fertility specialist at the earliest opportunity.

Not every patient will require or choose fertility preservation. However, every eligible patient deserves:

Accurate information about the potential reproductive risks

Timely access to fertility-preservation counselling

An opportunity to make an informed decision before treatment begins

Depending on the patient’s age, diagnosis and available time, options may include

Fertility preservation is a subject very close to my heart.

I recently encountered a young man who, before beginning chemotherapy and radiotherapy for a brain tumour, had specifically asked whether he should preserve his semen. He was reassured that his fertility would not be affected and that sperm cryopreservation was unnecessary.

After completing treatment, he developed testicular failure. Unfortunately, the opportunity to preserve his fertility before treatment had already been lost.

This case has stayed with me because the outcome may have been different if he had received timely counselling and referral.

Cancer itself, chemotherapy, radiotherapy, bone-marrow transplantation and certain surgical procedures can temporarily or permanently impair fertility. Similarly, severe endometriosis, ovarian or testicular tumours and other medical conditions may compromise future reproductive potential.

I sincerely request all oncologists, radiation oncologists, haematologists, bone-marrow transplant physicians, breast surgeons and gynaecologists:

Please discuss fertility with every young patient before starting potentially gonadotoxic treatment – and refer them to a fertility specialist at the earliest opportunity.

Not every patient will require or choose fertility preservation. However, every eligible patient deserves:

• Accurate information about the potential reproductive risks
• Timely access to fertility-preservation counselling
• An opportunity to make an informed decision before treatment begins

Depending on the patient’s age, diagnosis and available time, options may include sperm, oocyte, embryo, ovarian tissue or testicular tissue cryopreservation.

The oncology treatment plan must always remain the priority, but fertility counselling can usually occur without causing an unnecessary delay in treatment.

A referral does not guarantee future parenthood – but the absence of a timely discussion may permanently remove that possibility.

Let us treat the disease while also protecting the life our patients hope to live after recovery.”

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