Considerations for patients coping with fertility-threatening conditions
Teen/young adult (TYA) patients with fertility-threatening conditions, including cancer and gender transitioning, face the weighty decision about whether to preserve their chance to have biological children and how to do so. At Duke, a multidisciplinary team—including specialists from the Duke Fertility Center, the Duke Cancer Institute, Duke Urology, and a new TYA patient navigator—has redesigned care pathways to streamline fertility preservation and help survivors fulfill their wish to be parents in the future.
In this Q&A, Karen Baker, MD, a urologist who specializes in male fertility, describes Duke’s renewed focus on the TYA population and shares considerations for providers having a fertility preservation conversation with patients and families.
Q: Why do TYA patients need to think about fertility preservation?
The tremendous advances in cancer treatment mean that more and more children, teens, and young adults will reach the age when they may want to start a family and have children of their own. Taking the right steps to preserve sperm and eggs before starting cancer treatment can prevent a lifetime of regret for these survivors and help them achieve their dream of being parents.
Q: What has Duke done to provide TYA patients and their families with better access to fertility preservation?
Patients with cancer are under pressure to make complex and life-altering decisions in a short period of time. Thinking about the future during this emotionally time, much less seeking out fertility care, is challenging for patients and their families. And yet studies indicate that the chance to be a mother or a father in the future is very important to cancer survivors, and patients who miss this opportunity feel a deep sense of loss.
Duke has taken several steps to address the critical need to integrate fertility preservation into the cancer care plan. We created a patient navigator position dedicated to helping TYA patients and their families schedule and complete fertility preservation in conjunction with cancer treatment. We instituted a care pathway that streamlines evaluation and counseling, provides educational material and resources, and expedites sperm cryopreservation for both inpatients and outpatients. Our team of specialists leverages Duke’s resources, enabling many cancer patients to complete cryopreservation in as little as 1 to 2 days. Patients can then begin treatment with the peace of mind that they’ve taken steps to preserve their chance to be a parent.
Q: What fertility considerations do you recommend physicians make when counseling patients diagnosed with cancer?
First and foremost, providers should proactively discuss fertility preservation with their patients. Studies indicate that patients recently diagnosed with cancer are overwhelmed, and many will not think about future fertility unless it is specifically addressed by their provider. Second, unless a patient expressly states that they do not want additional children, I recommend entering a referral for fertility preservation. Our team will educate the patient about their options and give them the information they need to make an informed decision about sperm and egg cryopreservation.
And finally, it is important to recognize that cancer is not the only potential threat to fertility. Treatments for autoimmune disorders, rheumatologic conditions, and the hemaglobinopathies, and the medications needed to initiate and sustain gender transition, can also have a profound and irreversible negative impact on fertility. Fertility preservation should be offered to these patients as well.
Q: What suggestions do you have for encouraging TYA patients to consider sperm cryopreservation?
I tell TYA patients that freezing sperm gives them options: They aren’t deciding that they want to have children when they cryopreserve; they are deciding whether they want that choice in the future. Let’s face it: It is difficult for anybody facing a life-threatening diagnosis to think beyond their immediate treatment, and when you are a teen or unpartnered young adult, the decision to have a baby can feel a very long way off. I tell TYA patients that having children is important to many cancer survivors. I tell them that we want them to live full and rich lives, and that by freezing sperm, their future selves can decide if parenting will be part of that life.
Q: How do you recommend allaying concerns about the expense of cryopreservation?
Sperm cryopreservation is straightforward intervention with a huge future benefit, and it is more affordable than many people think. It costs a few hundred dollars to freeze sperm and a few hundred dollars a year to store the frozen sperm. Many companies offer reduced annual fees for patients with financial need, and foundations like LiveStrong can help defray some of the costs associated with cryopreservation. I tell patients that sperm cryopreservation is an investment for their future self—a simple step they can take so they have the family they want when they are a cancer survivor.