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ASRM to Oncologists: Fertility Preservation Referrals Needed

October 23, 2012

Research presented at the 68th Annual Meeting of the American Society for Reproductive Medicine (ASRM) reminds us that fertility preservation via egg freezing, while crucial to the cancer patient’s reproductive future, is still infrequently recommended by oncologists.

Teams from the University of North Carolina at Chapel Hill and the University of California San Francisco have uncovered vast disparities experienced by women with gynecological cancer in access to information regarding the future of their fertility.

These findings are similar to a study published in Practical Radon Oncology in September showing significant need for physicians to educate their patients on the effects of cancer treatment on fertility, and to follow through with referrals to a fertility specialist who will work with them to preserve their fertility. In this study, 82% of radiation oncologists “always/often” talked about the ways in which cancer treatment compromises fertility, while 51% of surgical oncologists started the conversation. Surprisingly, between 24% to 31% of these physicians “rarely/never” actually referred patients of reproductive age to a reproductive endocrinologist, or fertility doctor.

Findings presented at ASRM suggest that patients were not being counseled about the impact of cancer treatment on their fertility long-term. Over 2,000 adult women from the California Cancer Registry diagnosed with gynecological cancer between 1993 and 2007 were surveyed. Of these women, 50% were informed of the risks of cancer treatment on their fertility and only 3% pursued fertility preservation. Thirty percent of males were offered fertility preservation consultations as was discovered in a subsequent study.

There were significant demographic disparities between those who were informed of their preservation options and those who were not, including education level, whether or not the women were already parents, and insurance status. Women with a bachelor’s degree were twice as likely, and those with private health insurance were three times as likely to have the conversation with their oncologist. Conversely, women who already had children were half as likely to be counseled by their oncologist.

It is important to note that money is the biggest concern when it comes to egg freezing. Researchers presenting at ASRM discovered that 90% of women admitted finances and lack of insurance coverage were their reasons for not preserving their fertility.

Fortunately, there are programs like Fertile Hope, Fertile Action, and Fertility Rescue which offer fertility drugs and egg freezing for fertility preservation at little to no cost to the cancer patient.

Overall, an education initiative is needed to teach oncologists of the available options for fertility preservation and to encourage them to refer their patients for these services.

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