In a world where medical advancements are rapidly extending lifespans, the conversation around quality of life posttreatment is becoming increasingly important. For reproductive-age cancer patients, a critical component of that conversation is fertility preservation. Katherine McDaniel, MD, a reproductive endocrinology and infertility specialist with the University of Southern California and HRC Fertility, shed light on the evolving landscape of this crucial field, emphasizing the urgency, challenges, and hope it offers.
What Fertility Preservation Entails
Patient speaking with doctor: ©Mark Adams – stock.adobe.com
McDaniel explains that fertility preservation is a vital option for patients whose cancer treatments, such as chemotherapy, radiation therapy, or surgery, could impact their reproductive health. The primary focus for women is freezing eggs, which can also be combined with sperm to freeze embryos. For men, the core practice is freezing sperm.
She noted that while these are the main methods, there are advanced techniques for patients who aren’t candidates for traditional methods. “For instance, prepubertal girls aren’t candidates for egg freezing because they don’t have a mature connection between their brain and their ovaries,” McDaniel said. For these patients, a pioneering technique called ovarian tissue cryopreservation has emerged. “We actually remove a whole ovary, we freeze it, and then transplant it back into the patient when they’re ready to conceive, oftentimes decades down the road.”
A Shift in Awareness and Urgency
McDaniel has witnessed a significant change in the landscape of fertility preservation over the past decade, primarily in the form of increased awareness. “I think 10 or 15 years ago, many, many patients simply weren’t counseled on fertility preservation in the setting of their cancer diagnoses,” she said. “Understandably, because their teams wanted to focus on treating their cancer, saving their lives, which, of course, is extremely important.”
Today, however, she sees a greater understanding within the oncology community, leading to more referrals. A crucial part of this shift is the recognition of the urgency involved. McDaniel emphasized that she wants to see patients as soon as they receive their diagnosis, so they can focus on fertility preservation, “maybe even before their oncology team has a treatment plan.” This early intervention is key to ensuring a patient’s reproductive future isn’t overlooked in the rush to begin life-saving treatment.
The Barriers and the Hope for Change
Despite the growing awareness, significant barriers remain, with access to care being a major issue.
“So many of the treatments that we offer aren’t covered under insurance, so the cost is very prohibitive for a lot of patients,” McDaniel noted. She pointed to the variance in state-level mandates, highlighting the progressive step taken in California with Senate Bill 600, which mandates fertility preservation coverage. However, many states lack such mandates, leaving patients with substantial out-of-pocket costs.
“That access to care issue is really big and will continue to be an issue over the next few years and decades,” she said.
Additionally, as the age of cancer diagnoses decreases for certain cancers, a new challenge emerges: approaching young patients with sensitivity. McDaniel acknowledged that talking to teens about their reproductive future, especially those who may have had limited contact with the health care system, requires a delicate touch.
“It’s definitely something that we all need to remain sensitive to, and perhaps even more sensitive to as we have more and more young patients diagnosed with cancer,” McDaniel said.
A Call to Action for Oncology Colleagues
McDaniel has a clear message for her oncology colleagues: “Keeping the ASCO recommendations in mind that all reproductive age patients should be counseled on the impact of the cancer therapies on their fertility.” Her primary piece of advice is to refer patients as soon as possible. “As soon as that diagnosis hits your inbox in a reproductive-age patient, please call us, email us, refer us to your patients,” she said.
McDaniels highlighted that that fertility preservation treatments are time-sensitive and can be expedited to avoid treatment delays. “We are really sensitive to the expedited nature of treatment. We want to see these patients within 24 hours of them calling our clinics.”
She also highlighted the swift nature of the process itself, noting that treatment can often begin on the first day and be completed within 2 weeks. “We absolutely do not want to delay treatment in any way, shape, or form,” she affirmed. The message is clear: early, swift collaboration between oncology and reproductive endocrinology is the best path forward for patients facing a cancer diagnosis.