Navigating Cancer Treatment and Fertility: Key Steps Women Should Take

Jamie Forward:

So, Kristin, how do you help patients navigate the stress of balancing sometimes urgent cancer treatment decisions with long term family planning goals? 

Kristin Smith:

It can be really difficult. And everything needs to be done yesterday. So, we try our very best here at Northwestern to ensure that our patients have access to these services right away so that if a patient’s being seen in oncology, the oncologist can talk about fertility and say, “Hey, I’m going to make a referral to Kristin, and she’ll call you today or tomorrow.” And usually, that’s how quick it happens. And then, I feel very blessed within the Center For Fertility and Reproductive Medicine here at Northwestern. I have reproductive endocrinologists who are ready to see these patients at the drop of a hat. So, they’re constantly adding patients on for consults. 

And then, our team is also very ready to ensure that patients can get into a stimulation cycle as quickly as possible. Because we know if someone wants to freeze eggs or embryos, it’s going to take us about two weeks from start to finish. And sometimes that does mean a slight delay in starting their oncology therapy. But if we can get them seen as quickly as possible, we can minimize that delay so that patients really aren’t making a decision just based on timing alone.  

Jamie Forward:

Are there online resources for patients? Where can they start if they find themselves in this situation? 

Kristin Smith:

There are some really great online resources that have been built really over the past decade. So, the Oncofertility Consortium is a great website with a plethora of information on it. 

Another really great website is Take Charge. This is really geared toward oncofertility. And then, there are different organizations out there that help cover the cost of fertility preservation services. So, organizations like Chick Mission, and Worth the Wait, and Team Maggie’s Dream. All three of these websites, as well, will have really robust information and access to help pay for some of these services.  

Jamie Forward:

That’s excellent advice. Thank you for sharing those. So, Kristin, how can women advocate for their fertility needs during cancer treatment planning? How do you encourage them to speak up? 

Kristin Smith:

I think you have to ask. And I know that it feels really scary. You’ve been given all this information. You are looking at your life in a totally different way, and you feel like a lot of choices are being made for you. And the fertility piece is one choice that you can make for yourself. And so, it is really important to ask about it, and to be sure that your oncologist has heard you and heard how important fertility is or isn’t to you. 

And ensure that by asking, by making your wishes well-known, you get the referrals that you need so that there aren’t large amounts of regret down the line. And we know when we don’t talk about fertility preservation at time of diagnosis, there are huge amounts of regret during survivorship. So, as oncology professionals, as fertility professionals, as patients; this is a really important topic. And so, just by bringing it up, just by asking that question, “How does my treatment impact my future fertility?” You can really open up a dialogue about what options exist for you for fertility preservation.  

Jamie Forward:

Great point. Don’t ever hesitate to speak up. 

Kristin Smith:

Don’t hesitate. And I know it’s hard.  

Jamie Forward:

Sure. And so, when someone’s meeting with the fertility specialist, what sort of questions should they be asking? 

Kristin Smith:

Yeah. I think cost is a big barrier when it comes to fertility preservation. And while in the United States, we now have 21 states who have some type of fertility preservation legislation, largely thanks to the Alliance For Fertility Preservation.  

But it doesn’t mean that this is for sure covered for people. And so, if this isn’t a covered benefit, I think it’s really important to know what cost you’re going to be facing. It stinks that we have to worry about a bank account when we’re thinking about something as important as fertility preservation, but we all know that that’s a big part of this decision-making. So, I think understanding cost up front. 

And then, if there is cost associated with it, understanding what financial assistance organizations you can tap into. So, for medications, there are three different organizations between Livestrong, ReUnite, and the Heart Beat Program. These can all offer help with the very expensive fertility medications. And then, I had mentioned those other three organizations for help with the financial assistance piece and actually paying for the fertility preservation services of Chick Mission, Worth The Wait, and Team Maggie’s Dream. Those are some that I tap into regularly. And so, I think once you understand the cost implications of all of this, within the fertility clinic, too, it’s important to understand what is this process going to look like for me. 

How quickly can I get started in a stimulation cycle? Am I able to start as soon as I have medications in hand? Is there anything else I need to be waiting for? And I think also, too, it’s important to understand is this safe for me? And across the board, that answer’s going to be yes. But it is really important that your fertility doctor and your oncology team work hand in hand so that everyone’s on the same page about your timeline. Everyone understands when chemotherapy, or radiation, or a surgery can happen. And then, everyone also understands that this is a safe procedure. This egg retrieval will be a safe procedure for you moving forward.  

Jamie Forward:

Okay. And related to staying in communication between your fertility specialist and your oncologist, for example, is that something that even can be taking place on those online medical charts? 

Kristin Smith:

So, ideally. We would love for everyone to be on the same electronic medical record. And we’re lucky here at Northwestern that we are. So, literally I can see a patient and then send a note right to Oncology or even forward my own internal office notes to Oncology so they can see exactly what’s happening with these patients. 

But we know that many fertility clinics do not utilize the same electronic medical record that many oncology clinics will. So, I think this is where a navigator can be extremely helpful. Because oftentimes, that navigator is that communication person really talking to Fertility and then talking to Oncology to ensure everyone’s on the same page. If you don’t have a navigator, though, sadly as the patient, that’s kind of your job, and that can be a little bit more added to your plate that is already very, very full.  

But it is so important to make sure that everyone feels like they know what’s happening so that everyone can continue to schedule all these next steps that you need. All the testing that’s necessary. All the next treatments that are necessary to ensure that there really is as minimal delay into getting into treatment as possible.