I watch a young, 20-something mother playing with her dimple-faced toddler in our neighborhood park. We are well enough acquainted to know we have both survived cancer. I remember her undergoing chemotherapy for lymphoma several years ago. She confided once that she and her husband were trying to conceive a second child, "But I'm lucky to have this one," she said. "Because of chemotherapy, becoming a mom was a miracle for me."
Her joy of motherhood makes me hope fertility consultations for all young adults with cancer are more than a passing mention of "We have a good chance of saving your life, but cancer treatment may render you infertile," from their oncologist. By the time I meet them in the infusion clinic to administer chemotherapy, the window of opportunity for fertility preservation is rapidly closing for these patients, if it hasn't already.
Punch & Judy
Fertility preservation is not just a simple referral to a reproductive endocrinologist, however. Fertility preservation is expensive. Initial specimen collection fees for men start at $800, with annual storage fees ranging from $200 to $400. However, for women, fees begin at $10,000. Some insurance companies cover fertility preservation the same way they are mandated to cover reconstruction following mastectomy for breast cancer, and sometimes cover wigs for alopecia, but not always.
This brings to mind a young cancer patient, enrolled in college, wondering how he will maintain his scholarship and student loans, let alone pay for sperm banking perhaps for years, while his parents and girlfriend begged him to do it.
Uninsured, young adult patients are not financially prepared for this option, and often face overwhelming challenges regarding treatment costs, let alone preserving fertility.
For many young adults with cancer, it's not until their peers begin marrying and/or family planning that the consequences of cancer treatment on their fertility takes precedence. Those who consider fertility preservation at time of diagnosis, however, may not be able to afford it.
If fertility preservation were less expensive, would more young adults, and the parents making the decision for children diagnosed with cancers, choose it?