Oncofertility

What is Oncofertility?

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. The name was coined by Teresa K. Woodruff at the Oncofertility Consortium.

Why is it a concern?

Survival rates have increased for young people diagnosed with cancer as treatment options have improved over the years. This has prompted the need to have discussions about fertility. When a patient is first diagnosed with cancer their fertility may not be at the forefront of their mind since they are dealing with a life altering diagnosis. Many doctors are concerned for the health of their patients and are consumed with providing the right treatment plan. Not often are oncofertility options provided prior to treatment. This can lead to a gap in care for those who plan to have a future family.

How does treatment affect fertility?

1. Chemotherapy can damage sperm in men and sperm-forming cells in young boys. It can cause primary ovarian insufficiency in women.

2. Radiation Therapy to the abdomen, pelvis or spine can harm nearby reproductive organs. Radiation to the brain can harm the pituitary gland. This gland plays an important role in fertility.

3. Surgery for cancers of the reproductive organs and for cancers of the pelvis region can harm nearby reproductive tissues, organs, nerves, lymph nodes and cause scaring leading to infertility.

4. Stem cell transplants such as bone marrow transplants and peripheral blood stem cell transplants involve receiving high doses of chemotherapy and/or radiation. These treatments damage the ovaries and sperm leading to infertility.

5. Hormone therapy, also called endocrine therapy can decrease the production of sperm and disrupt the menstrual cycle.

6. Immunotherapy and targeted cancer therapy are areas of ongoing research. Less is understood but may affect fertility outcomes.

What are the challenges?

1. Expertise – Lack of provider comfort or knowledge in fertility preserving methods, including risks, indication and timing.

2. Insurance Coverage – Most insurance plans do not provide coverage for fertility issues. As of 2023, only 16 states have mandated insurance coverage for iatrogenic infertility. Within these states the level of coverage is variable.

3. Cost – Cost of fertility services not covered by insurance are high. Patients have reported debt exceeding $25,000 US Dollars related to fertility preservation. These services include egg/sperm/embryo freezing, extraction, cost of drugs, donor eggs/sperm/embryo, surogacy, adoption and more.