Guideline development process

These guidelines provide evidence-based recommendations and consensus-based recommendations to assist health professionals discuss and manage fertility preservation for people with cancer, including:

• The potential impact of cancer treatments on fertility
• Referral pathways and oncofertility service provision
• Fertility preservation options for people diagnosed with cancer
• Supporting and managing conception and pregnancy in cancer survivors

The guidelines incorporate evidence for children, adolescents and young adults (AYAs) and adults of reproductive age that have been diagnosed with cancer.

The guidelines were developed by a multidisciplinary Working Group, supported by a COSA Project Manager. The guideline development process involved conducting literature searches, appraising the literature, and formulating and grading recommendations (detailed below).

These guidelines replace the 2011 guidance for health professionals titled Fertility preservation for adolescents and young adults (AYAs) diagnosed with cancer, produced by the Clinical Oncology Society of Australia (COSA) as part of a national Youth Cancer Networks Program project funded by the Australian Government, administered by Canteen.

The need to expand and update the 2011 guidance was identified as a priority by the COSA AYA Group Executive Committee. The project was approved by COSA Council and a COSA Project Manager assigned; no external funding was received to develop these guidelines.

COSA would like to thank all the members of the working group who contributed their expertise and time to the development of these guidelines. Membership of the working group can be found here.

Conflict of interest register

Working group members have declared the following conflicts of interest:

Kate White: Payment for education session from Bristol Myers in 2021.

Roger Hart: Medical Director of Fertility Specialists of Western Australia; has equity interests in Western IVF; has received educational grants from MSD, Merck and Ferring Pharmaceuticals; has received honoraria from Merck. No other conflicts of interest reported.

Kate Stern: Received prior to 2020 non-directional grants for Future Fertility Registry and Ovarian Tissue Grafting program.

Robert McLachlan: Consultancy and equity holder, Monash IVF Group.

Wanda Cui: Grant funding from BCT outside submitted work. Honoraria from Janssen and AstraZeneca.

These clinical practice guidelines are based on a systematic review of published literature. The working group developed clinical questions which determined the scope for the guidelines. The search strategy and literature search was conducted by the Project Manager in consultation with the working group. Authors were assigned to appraise the relevant literature and to formulate evidence-based recommendations where possible and consensus-based recommendations where the evidence was of insufficient quality.

The steps followed by guidelines authors are outlined below:

1. Structure the clinical questions
2. Develop a search strategy
3. Search the literature
4. Critically appraise the literature
5. Formulate and grade recommendations

Develop a search strategy

Appropriate search strategies were constructed for each clinical question. MeSH terms were agreed by working group members and were expanded by the Project Manager after conducting pilot searches and searching the MeSH vocabulary. Where there was no appropriate MeSH index term available a combination of free text words were used in order to capture the relevant data.

The following exclusion criteria was applied: languages other than English. This exclusion criteria was then refined for each individual clinical question. The search strategy was approved by the members of the working group and can be found in the appendices of each page of the guidelines.

Search the literature

Searches were completed primarily in PubMed. Search results were screened for relevance by the Project Manager. The relevant literature was collated, full-text articles obtained and sent to working group authors to include or exclude, critically appraise and use as the evidence base for their clinical question.

To view more detailed information about the literature search (such as inclusion and exclusion criteria) and the results of the search, please go to the relevant page of the guideline. The information can be found in the appendices on each page.

Critically appraise the literature

Relevant articles selected from the literature search were reviewed by the clinical question author and each article was critically appraised with respect to level of evidence, quality of the evidence, size of the effect and clinical importance and relevance. Level of evidence was assigned according to the following criteria from the NHMRC Evidence Hierarchy:

Source: National Health and Medical Research Council. NHMRC levels of evidence and grades for recommendations for developers of guidelines. Canberra: NHMRC; 2009.^[1]

Formulate and grade recommendations

The body of literature was assessed by each author and recommendation grades were assigned using the following criteria adapted from the NHMRC body of evidence matrix:

¹ Level of evidence determined from level of evidence criteria

² If there is only one study, rank this component as ‘not applicable’

³ For example results in adults that are clinically sensible to apply children OR psychosocial outcomes for one cancer that may be applicable to patients with another cancer.

^** For a recommendation to be graded A or B, the volume and consistency of evidence must also be graded either A or B!

Source: National Health and Medical Research Council. NHMRC levels of evidence and grades for recommendations for developers of guidelines. Canberra: NHMRC; 2009.^[1]

Recommendation grades are indicated below:

Adapted from: National Health and Medical Research Council. NHMRC levels of evidence and grades for recommendations for developers of guidelines. Canberra: NHMRC; 2009.^[1]

Write the content

Question authors were asked to write the content for their guideline section using the following format:

• background
• review of the evidence
• evidence summary with levels of evidence and numbered references
• recommendation(s) and corresponding grade(s)
• references

Review of question content

The body of evidence and recommendations for each question topic were reviewed by the working group and final recommendations agreed to, based on the evidence.

The draft guidelines were released for public consultation to all interested parties in Australia. The consultation process involved seeking public review of the draft guidelines through email to COSA members, posting on the Cancer Council Australia Cancer Guidelines Wiki (previous guideline hosting platform) and alerting stakeholders including professional societies and other interested groups by link to the site. All feedback on the draft received during the consultation period was reviewed by the guideline working group. Subsequent changes to the draft were agreed by consensus of the guideline working group, based on consideration of the evidence.

Public consultation open: 2 June 2021

Public consultation closed: 28 June 2021