What is Oncofertility?

What is Oncofertility??

According to UCLA Health, Oncofertility refers to the medical field that bridges the specialties of oncology and reproductive endocrinology with the purpose of maximizing the reproductive potential of cancer patients and survivors. Differing cancer treatments, radiation, and surgery can be the cause of infertility or inability to conceive children later in their life for both men and women (UCLA Health).?

When undergoing chemotherapy there are a few different options to preserve fertility for those with ovaries:

1. Crypto-Preservation (eggs or embryos)
2. Egg freezing begins with hormonal stimulation of the eggs that can then be harvested for future use. This process can take anywhere from 2-6 weeks. According to Livestron, “Egg freezing costs approximately $11,900 per cycle, plus $300–$500 per year for storage, and has a success rate of 36–61 percent per transfer” (Livestrong).
3. Embryo freezing is similar to egg freezing but eggs are then immediately fertilized with her partner’s sperm to create embryos, which are then frozen for future use. Embryo freezing costs approximately $12,400 per cycle of IVF, plus $400–$600 per year for storage. This option has a success rate of 30–40 percent, though it varies by maternal age and reproductive center (Livestrong).
4. Ovarian transposition is the process of moving the ovaries out of the pelvis through surgical techniques in cases where pelvic radiation is required in order to minimize the damaging effects of ionizing radiation on the ovaries.
5. Radiation Shielding is where the genital and pelvic region with a lead apron during radiation therapy to minimize the damaging effects of ionizing radiation on the ovaries and testes.

There are a few other options available but they are still considered experimental so I will not include them in this post. In addition to options for preserving there are outside interventions such as donor eggs, donor sperm, the use of a gestational surrogate and adoption.?

Are oncofertility treatments currently covered by insurance?

Information gathered from the National Academy for the State Health Policy, “Since 2017, 15 states have introduced legislation that would mandate coverage of fertility preservation – which includes the removal and storage of eggs and sperm – prior to radiation and chemotherapy treatment for cancer. Five states – Connecticut, Rhode Island, Maryland, Delaware, and Illinois – have enacted this legislation, and New Jersey has a bill pending (National Academy for State Health Policy). The state of CA has bill SB 600 that “? covers fertility preservation such as sperm banking and egg freezing, which is done before medical treatment that can cause infertility. The bill does not apply to fertility services after a person finds out he or she is unable to have biological children. A separate bill that would have required fertility treatment to be covered in all cases failed to pass the Legislature” (Gutierrez).

We can see that in just the last few years there have been great strides in terms of aid for helping patients afford these treatments. It will be interesting to see how they are covered in the future as more people will utilize the options available to them.?

References

Gutierrez, Melody. “Fertility options for cancer patients must be covered under new California law.” Los Angeles Times, 13 October 2019, https://www.latimes.com/california/story/2019-10-13/california-health-insurers-cancer-patient-fertility-options. Accessed 29 January 2023.

Livestrong. “Fertility Preservation Options for Women.” Livestrong, Livestrong Foundation, 2021, https://www.livestrong.org/we-can-help/fertility-services/fertility-preservation-options-women. Accessed 29 January 2023.

National Academy for State Health Policy. “States Add Coverage Mandates to Cover Infertility Treatment following Cancer Treatments.” NASHP, 20 Novemeber 2018, https://nashp.org/states-add-coverage-mandates-to-cover-infertility-treatment-following-cancer-treatments/. Accessed 29 January 2023.

UCLA Health. “Oncofertility - Fertility & Reproductive Health.” UCLA Health, 2023, https://www.uclahealth.org/medical-services/obgyn/fertility/oncofertility. Accessed 29 January 2023.