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A Reproductive Endocrinologist Discusses Need to Cover Fertility Intervention in Cancer Care

Surabhi Dangi-Garimella, PhD
The American Journal of Managed Care® spoke with Jane L. Frederick, MD, FACOG, a reproductive endocrinologist and fertility specialist, about the changing landscape of cancer treatment, partnering with oncologists, and helping patients gain financial assistance for their fertility preservation and treatment.
With earlier diagnosis and better treatment options that improve survival outcomes, patients being treated for cancer have a few other things to worry about. Awareness around the impact of anticancer agents on patient fertility has resulted in patients seeking fertility preservation prior to treatment. However, challenges remain around insurance coverage for fertility preservation.
The American Journal of Managed Care® (AJMC®) spoke with Jane L. Frederick (JLF), MD, FACOG, a reproductive endocrinologist and fertility specialist who works with HRC Fertility, California. Frederick spoke about the changing landscape of cancer treatment, partnering with oncologists, and helping patients gain financial assistance for their fertility preservation and treatment.
AJMC®: Can you describe your practice and the patients with cancer that your practice serves?
JLF: I am a specialist in the reproductive endocrinology and fertility role, with over 27 years of experience, and in the last 15 years, we as an industry have been
able to perfect the art of freezing eggs for fertility preservation. I have been seeing an increasing number of patients who have a cancer diagnosis and are getting referred for fertility preservation. The good news is that cancer is getting diagnosed earlier, people are getting treatment earlier, and the treatment that we have is more effective—that means we are seeing more cancer survivors. As a specialist in fertility, it’s important that we offer cancer survivors the opportunity to have their own genetic offspring.

So, whereas in the past when you got the diagnosis of cancer your fertility was over because we couldn’t help you freeze your eggs, at least as a woman, now I
get those referrals to have the patient undergo an IVF [in vitro fertilization] procedure—I can successfully get [the patients] in my office, and within 2 or 3 weeks I
can have them undergo an IVF cycle, freeze their eggs, and get them back into treatment with their oncologist. I would say the fact that we’ve been able, as specialists, to perfect the art of freezing an egg and allowing it to survive, gives these patients hope to come back to have a family. For me, that’s really a great
reward as a fertility specialist, and it’s something I’m very passionate about.
AJMC®: What has increased infertility referrals: patient awareness or oncologist awareness?
JLF: The consumer is more aware that when they get the diagnosis of cancer that there are options for them. There’s always been that option for males to come in and freeze their sperm, but I think women are more aware that this option is available and I am seeing more and more oncologists allowing the patient to have this information and come see me for an evaluation.

For a long time, we battled the philosophy from the oncologists that:
  • It won’t work
  • The myth was that my treatment would postpone chemotherapy
  • Whatever I’m doing would contribute to the unsuccessful treatment of the oncologist
There have been many studies showing that delaying chemotherapy treatment may not be possible for every tumor or diagnosis—some patients need to be treated the day after the diagnosis if it’s that bad. But, if the oncologist feels there is time, and can get a referral and get an opportunity to freeze the egg, then I am seeing more and more oncologists understand that. There are many studies showing that my care and my procedures are not delaying the success of that patient being a cancer survivor.
AJMC®: What is the duration of time for the patients, after they consult with you, before they can start their cancer treatment?
JLF: When I get a call from a patient with cancer, male or female, my office knows that they are given priority to see me in the next 24 hours. I’ve educated my staff [to understand] that these patients are very special and we need to get them in right away.

If the oncologist has [told the patient] that your type of tumor has a window of opportunity here, then I can start the patient on the stimulation drugs within a week or so of her seeing me, and then I can have her undergo an egg harvest at the end of the 2- or 3-week period. On the day following the egg harvest, she can go back and start her chemo.

The other factor that I’ve been a pioneer in is trying to get the industry—the fertility industry, the pharmaceutical companies, for example—to pay for the medication costs of the cancer patient because the medication for IVF can be a couple thousand dollars and usually insurance doesn’t cover it. So, I now have resources for the patient to reach out to, such as Fertile Hope and the LIVESTRONG Society. I’ve partnered with them to allow the patient to get the pharmaceutical meds that they need to get started. Then, as the center of excellence, my services are greatly reduced in cost so that we can get patients in for treatment and that helps them cost-wise. The goal is to spread the word that this is available and it’s an opportunity to preserve the fertility for the woman with cancer—we’ve already been doing that for the male patient for many, many years—but the success of egg freezing is only recent.

The key is to spread the word, not only to the consumer but also to the oncologist, because we don’t want them to feel that this procedure would be detrimental to their treatment and their survivor rate.

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