On Cancer and Fertility Preservation

One small part of the domain of fertility care pertains to preservation of fertility in the setting of malignancy.    I have treated fertility problems in men who have been treated for various cancers with chemotherapy, and or radiation therapy.    I have also diagnosed men with  diseases such as prostate cancer and testicular cancer  and have discussed  preservation of fertility as part of their cancer care.

Unfortunately,  for a number of patients,  fertility preservation is simply not covered.   This summer, it was announced that Rhode Island became the first state to pass a law explicitly requiring coverage of fertility preservation prior to, treatment that could directly or indirectly cause infertility.

A perspective on this mandated coverage in Rhode Island and similar legislation in Connecticut has been published in the October 26, 2017 edition of the New England Journal of Medicine  penned by authors Cardozo, Huber, Stuckey and Alvero.   

In the article, it is noted that that several obstacles for equal access to fertility preservation and care including the fact that legislation applies to private insurance and not to government-based payers.

Insurance coverage for fertility treatment

New Jersey Residents are fortunate to live in one of only fifteen states that mandate that insurers offer some form of coverage for fertility treatment and in fact, of the 15 states, New Jersey has one of the most favorable rules.   Even in states where fertility coverage is mandated, it is not always the case that fertility preservation is also covered.

In general, for men, fertility preservation essentially means sperm banking from ejaculated specimens.  However there are some situations where the issue becomes  more complicated.  This happens in patients who either have no sperm in the ejaculate or are unable to ejaculated.  

Treatment in these situations may include attempts at retrieving sperm from the bladder in cases of retrograde ejaculation, or surgical sperm retrieval in cases of azoospermia or no sperm in the ejaculate.   Success of these approaches depends on the underlying mechanism behind these problems

When sperm are retrieved, generally cryopreservation is best performed by a sperm bank that is AATB (American association of tissue banking) certified or a facility that performs in vitro fertilization. 

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