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While many patients receiving gonadotoxic agents have a malignant hematological condition, cancer therapies are increasingly used for the treatment of other hematological conditions, such as: sickle cell disease, autoimmune thrombocytopenia, aplastic anemia, and thalassemias. Currently, hematopoietic stem cell transplantation (HSCT) is the only treatment for certain hematological conditions, like sickle cell disease, that offers the opportunity for a complete cure. However, infertility, premature ovarian insuffiency, and azoospermia are common following the conditioning regimens typically used for HSCT. As recommended by the American Society of Clinical Oncology, the reproductive risks of cancer therapies and fertility preservation options should be routinely discussed with patients prior to treatment.
Hematologists can help patients by initiating conversations regarding the adverse effect of certain hematological conditions and their treatments on fertility. To determine the best fertility preservation option, patients should have a fertility preservation consultation with a reproductive endocrinologist. The Oncofertiltiy Consortium can assist hematologists with the referral process. The Oncofertility Consortium® provides a variety of oncofertility resources for hematologists for futher fertility preservation education and communication strategies.
Given the elevated risk of thrombosis and predisposition to painful vaso-occlusive events with many hematological conditions, it is critical that the hematologist keeps an open line of communication with the reproductive endocrinologist and is clear about what can be done in terms of treatment. Fertility preservation in patients with hematological conditions is not straightforward and requires a multi-disciplinary team approach to adequately address and minimize the risks in this unique patient population.
In addition to a reproductive endocrinologist, you may wish to involve the following health care providers in the fertility preservation process:
- Genetic counselors- due to the hereditary nature of many hemotological conditions, genetic counseling is advised for couples who have an inherited disease or carry the trait and want to begin families.
- Psychologists and social workers- transplant-induced infertility can be associated with significant psychological distress in long-term survivors and their respective partner if they wish to conceive a child.
Join the National Physicians Cooperative, a nationwide network of health care providers and fertility preservation centers who share the common goal to protect and preserve reproductive health through the continuum of care of care and across the lifespan of patients.
National Physicians Cooperative Membership Benefits
- Access to a national referral network for patients seeking fertility preservation
- Information on how to establish a multidisciplinary Fertility Preservation program
- Training in the best practices, including technology updates and practice management
- Templates and assistance for obtaining IRB approval for participation in multicenter NPC studies
- Access to materials and tools as needed to support clinical studies
- Compensation for the time and materials required to freeze tissues for the research pool
- Invitations to Virtual Grand Rounds, annual meetings, special events
- Information about the financial aspects of fertility preservation
- Use of a Fertility Preservation Brochure tailored to your program
Implement a Fertility Preservation Program
The Oncofertility Consortium and National Physicians Cooperative provide resources to assist providers intereted in implementing a fertility preservation program.
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Education and Communication Strategies
The Decision Tool Web Portal is a library of existing fertility preservation resources designed to help hematologists navigate fertility preservation conversations. Available Resources include:
- Communication strategies for discussing fertility preservation options with patients of all ages and their family members
- Decision tools and aids designed to guide patient fertility preservation discussions
- ASRM clinical guidelines and recommendations
- Information on existing and experimental fertility preservation techniques and technology
- Print and online patient educational resources
Each patient needs an individualized consultation to determine the best and most mature technology available in their unique circumstances and according to their informed choice. To refer a patient for a fertility preservation consultation, call the FERTline at 312-503-FERT or 866-708-FERT and print out this flyer to give to your patients.
Patients are often concerned about the cost of fertility preservation procedures. To learn more about insurance coverage for fertility preservation, read Incorporating Insurance Education into the Fertility Preservation Process from Oncofertility Communication (2014) or check out the Oncofertility Consortium® blog post on Insurance Coverage for Fertility Preservation.