For October’s Breast Cancer Awareness month, we hosted a free webinar that dove into fertility preservation for cancer patients. Receiving a cancer diagnosis can turn your world upside down, but understanding your fertility options from day one can make all the difference. Thanks to earlier detection and improved treatments, survival rates among cancer patients have steadily increased over the past four decades. As a result, focus has shifted from immediate treatment to life after cancer too, including future family building. Since many cancer treatments can impact your future fertility, it’s important to explore your options.
Fertility Preservation for Cancer Patients: Focusing on Survival and Your Life After Cancer
- Meghan Curci, Progyny Patient Care Advocate
- Jaime Knopman, M.D., Director of Fertility Preservation at CCRM New York and part of Progyny’s Provider Network
- Emily Rich, VP of Strategic Planning and Operations at UJA and Progyny member
- Joyce Reinecke, J.D., Executive Director at Alliance for Fertility Preservation
Here is a recap of the webinar with a few highlights
Approximately 1.5 million Americans are diagnosed with cancer a year, just under 10% of whom are under 45, so of reproductive age.
There are three main groups of people that need to think about oncofertility:
- Those who have never had children or haven’t completed their family building journey
- Newly diagnosed patients including children
- Survivors who have gone through treatment but don’t understand how treatment affected their fertility
Shift to Life After Cancer—Not Just Immediate Treatment
For reproductive age cancer patients, the survival rate is now around 80%. As survival rates have improved over the last few decades, there has been a shift away from only focusing on immediate treatment to a more holistic approach at life after treatment too, which includes fertility preservation. It also helps that reproductive technology has improved vastly in the last 10 years, which means egg, embryo, and sperm freezing is a much more viable option for many patients.
Cancer Treatment Affects Fertility
There are four main ways cancer treatment can affect your fertility:
- Medications, such as chemotherapy, can reduce your egg or sperm quantity and quality.
- Radiation can damage ovaries or testes.
- Surgeries, especially removal of affect reproductive organs, can affect your fertility.
- Time can affect fertility too. For example, a woman diagnosed with breast cancer at 32 and put on fertility suppressing medicine like tamoxifen for 5 years will have a much smaller chance of getting pregnant at 37.
Fertility Preservation Options for Cancer Patients
The main fertility preservation option is cryopreservation — egg, embryo, and sperm freezing. The egg freezing and embryo freezing processes are exactly the same for the patient, only difference is the fertilization in the lab. More people opt to undergo egg freezing as they retain control of their eggs versus sharing embryos with a partner
Ovarian or testicular tissue freezing is also an option, though they are still experimental procedures and are currently only done in a few select fertility centers or academic institutions.
You already have so many huge new decisions on your cancer journey, so ideally your oncologist should raise fertility preservation options with you. If your own doctor doesn’t, raise it as early as possible so you have the longest issue of opportunity—and therefore choices. Here are some questions to ask your oncology team:
- Will my cancer or its treatment impair my fertility going forward?
- What are my options to preserve my fertility and which is best?
For those survivors who have already gone through treatment or those who do not have time to preserve their fertility before their treatment, there are still family building options and it’s worth speaking to a reproductive endocrinologist to work out exactly what choices you have on your path to parenthood. There are always family building options as there are many ways to be a parent. Egg donation, sperm donation, surrogacy, or adoption are always possibilities.
The Oncofertility Process from a Patient’s Perspective
Emily Rich was diagnosed with very rare breast cancer and although her diagnosis came as a shock, she had a very strong support system, especially in her husband who is a testicular cancer survivor. She realized that she didn’t have the luxury to take time with decisions, including ones about fertility preservation. Initially, she didn’t want to preserve her fertility at first because she was nervous to put her body through more stress. However, once she understood the process wasn’t going to affect cancer outcomes or relapse rates, she elected to move forward with the embryo freezing process.
For Emily, the whole process took around a month. After only one appointment with her oncofertility specialist, she was faced with the decision about whether she wanted to preserve her fertility. Because of time constraints, Emily did her egg freezing round between surgery and radiation treatment and the process took around two weeks including all injections, monitoring, and the egg retrieval surgery. Then her eggs were fertilized with her husband’s sperm after genetic testing they were notified about their successful embryos. For Emily and her husband, the next step is to transfer one of her healthy embryos and start their family.
Initially, Emily was working with traditional insurance and because their cap was $15,000, she and her husband were facing high out-of-pocket costs—even with going through a subsidized program at their fertility clinic. This financial burden was a large factor in her hesitancy to move forward with fertility preservation, especially as with traditional insurance there always seems hidden costs that you don’t find out about until after the fact. However, just as she was about to be anesthetized for her egg retrieval surgery, her husband was notified they now had Progyny through his employer. He immediately called Progyny and by the time she was out of surgery, her husband had spoken to Kendra, their dedicated Patient Care Advocate, and their coverage was sorted. Emily never saw another bill from the doctor’s office, everything went through Progyny.
Emily acknowledges how lucky she was. “We were lucky, and I want to make that very clear. Ian and I are two very privileged people who had access to these benefits but there are so many women and families who are desperate to have a family or to preserve their fertility for when the time is right—and not just because of the cost—the emotional, the physical, and the financial cost—but also because of the lack of access to this care, they are denied that right. Progyny brought that access directly to us and they turned one of the hardest situations that we had to face into positivity and preparedness and one that felt respectful and thoughtful.”
Joyce Reinecke also went through fertility preservation when she got a very rare cancer in her 20s. She did one round of fertility preservation and because she was married, she elected to do embryo freezing versus egg freezing. Joyce and her husband then used a surrogate and ended up having twin daughters. Joyce also had to make the decision to preserve her fertility very quickly and because she had good insurance through her husband’s work, some tests were covered, and financially they were in a position where they could pay for the rest of treatment out of pocket.
Does Fertility Treatment Make My Cancer Worse—Or Risk Recurrence?
Fertility treatment doesn’t appear to increase the likelihood of recurrence or make cancer worse. Because it doesn’t advance cancer, it’s a good idea for cancer patients to at least explore the idea of fertility preservation.
Preserving your fertility can be an expensive process, even for those who are undergoing oncofertility treatment. If you want to begin the process, the first step is to check with your insurance to see what is covered. Some companies, like those who offer the Progyny benefit, have additional fertility coverage, so it’s worth asking your HR team too. For those that don’t have coverage or only have partial coverage, there are financial assistance programs such as Chick Mission, Livestrong Fertility, and the Heartbeat Program. It’s also worth speaking to your oncofertility specialist and see if you can negotiate a discount, as many providers offer subsidized rates for cancer patients.
Support and Advocacy
There are a lot of parallels between the cancer journey and the infertility journey, and infertility can be just as traumatic. It’s really important to find communities and meet people who have made these hard choices.
The Alliance for Fertility Preservation – is a charitable organization that has a mission to increase information, resources, and access to fertility preservation. The Alliance is made up of a team of professionals who have chosen to join together to advance the field of fertility preservation. They also try and connect people with experimental treatments like testicular tissue freezing that can be hard for patients to have access to. They’ve found that the cost barrier is the main hurdle for patients, so they have moved to advocacy to improve insurance coverage. Just recently, new insurance mandates mean 30 million more people have coverage for oncofertility.
Chick Mission — is a non-profit organization focused on critical issues unique to cancer patients including fertility challenges following treatment. They aim to ensure that no woman with a cancer diagnosis has to choose between her life savings and her future family. They advocate for change in congress, offer support, and also have grants for fertility preservation.
The Breasties – is a nonprofit support group that was born out of necessity. When the co-founders were going through their own journeys surrounding cancer, they found personal comfort in dreaming up a group that made all young women dealing with high risk or diagnosis feel supported.
If you’re a Progyny member, please reach out to your dedicated Patient Care Advocate with any questions related to this webinar or to your benefit. For those without coverage, visit progyny.com/talktohr to learn more about how you can get comprehensive fertility coverage at your organization.