What Fertility Preservation Challenges Do Women with Cancer Face?

Jamie Forward:

So, outside of financial resources, what are other common barriers to accessing fertility preservation? 

Dr. Terri Woodard: 

I think one thing is just the knowledge gap, both on the side of patients as well as providers. I think as providers, we’re not always prone to talk about things that we don’t know a lot about, so we might skip over it if we don’t feel comfortable talking about it. And I think specifically, providers who aren’t taking care of young women routinely might not even think about it. And then, on the other hand, as a young cancer patient, say you’re 22 years old and in college, doing all you can not to get pregnant, and then we’re throwing this infertility thing at you, you don’t even really know or it’s not on your radar to even ask about it.  

Certainly, there are other barriers in terms of geographic access, so people who live far from cities with fertility clinics. I see patients where the nearest fertility clinic may be a couple hours away.  

So, that’s another barrier. And then, of course, yes, financial is probably the biggest barrier of them all. 

Jamie Forward: 

Sure. And are there any support organizations to help with the financial side of it? Do you know of any nonprofit, advocacy groups, for example? 

Dr. Terri Woodard: 

Actually, yes. So, there are several that I can think of off the top of my head. Livestrong has had a fertility assistance program for many years now. There’s also a wonderful group that works with several states throughout the United States called Chick Mission, who will pay the cost of egg freezing for women with cancer. There’s also another great resource from the Alliance for Fertility Preservation. And their main goal is actually to help pass legislation that will cover fertility preservation for patients with cancer. But they also have resources on their website that patients can utilize to try to get additional assistance.  

And then finally, for medications, some of the drug companies actually offer assistance. So, Walgreens Heartbeat Program will cover a lot of the medications if there is a cancer diagnosis. 

Jamie Forward: 

That’s great information. Thanks for sharing those resources. I should also mention that our program partner, Worth the Wait, provides financial support and educational resources for fertility for cancer survivors. Scan the QR code on your screen to learn more. 

Dr. Terri Woodard: 

Yeah, Worth the Wait is awesome. And they also help with gestational carriers, post-treatment for survivors who may not have had this opportunity. 

Jamie Forward: 

Wonderful. That’s great to know. So, let’s talk a little bit about the emotional side. I know that you’re involved in the psychosocial aspect of fertility preservation. So, can you share a little bit about this? What are the common issues? 

Dr. Terri Woodard: 

So, I think the first thing is that patients are just overwhelmed.  

They’re overwhelmed by the information about their cancer diagnosis. And then, you add infertility or the threat of infertility on top of it, it’s hard for people to manage. I think one thing that really struck me when I started doing this work is that sometimes patients want you to tell them what they should do. And this is really a values-based decision. So, our job is to provide information. It’s to give them context for their own decision-making and their values, but we can’t really tell them what to do. But we’ve tried to develop some ways to make it easier for them.  

Occasionally, I’ll run into patients that are really distressed about this, and that’s when I will often refer them to reproductive psychologists or counselors that can help them delve into this a little deeper than what I can do in the clinic.  

But I do want to stress to patients that there are resources, and this is not an easy decision to make. And sometimes you don’t even have much of a decision, you’re really sick and we have to start treatment right away. Fertility preservation might not be an option. But I think it’s important to remember that we can always circle back to this. There are so many ways to build families these days. So, you know, don’t give up. 

Jamie Forward: 

Sure. And can you tell us a little bit about your research in this area? 

Dr. Terri Woodard: 

Yes. So, because I was running into this issue of women saying, “Well, just tell me what to do,” I learned about a whole field of science called Decision Science. And what we did was develop a decision aid for women who have been newly diagnosed with cancer and who have to make these decisions. And the wonderful thing about this decision aid is that it was really designed by patients for patients. So, they told us what they wanted.  

They wanted to see testimonials from other women who had to make various decisions. They wanted to know about the processes, the effectiveness rates, the cost, all of that. And in this decision made, we also embedded some values-based exercises because, like we were talking about earlier, many of these women might not have even thought about having children. So, there’s a list of questions about, what’s really important to them or what they think they might want in the future. 

Jamie Forward: 

Sure. And so, how can someone access this decision aid? 

Dr. Terri Woodard: 

So right now, we’re just working on getting it dispersed throughout MD Anderson, but we’re hoping in the next year or so, it will be available to everyone. And that was always the intent. For instance, we said that one of the big barriers might be geography. Well, in this decision aid, there’s actually a find a clinic link. So, someone can put in their ZIP code and figure out what the nearest clinic is or where it is with regard to where they live.