Fertility Services

Recommendation:

Oncofertility care services are available to patients either on-site or by referral prior to the start of cancer therapy.

Overview

Oncofertility care refers to patient-centered care that optimizes quality of life and family planning by anticipating and addressing fertility concerns.  The availability of fertility preservation services is an essential part of cancer care, beginning at the time of diagnosis and prior to initiation of treatment and through survivorship.

Oncofertility care services include, but are not limited to, the following:

  • Team-based care planning that involves the patient and family (parents or partners)
  • Communication among patients, families, and provider team
  • Continuity of care across a range of clinical settings and services
  • Psychosocial support for patients and families
  • Financial assistance

Standards

Commission on Cancer Cancer Program Standards, 2016: Standard 4.6

National Comprehensive Cancer Network (NCCN):

  • “Discuss risks of infertility due to cancer and its therapy, as well as options for fertility preservation”
  • “Discuss risks of infertility due to cancer and its therapy (especially for high-risk therapies such as alkylating agents or gonadal irradiation), fertility preservation, and contraception prior to the start of therapy”
  • “Initiate referral for fertility preservation clinics within 24 hours for all patients who choose this option of fertility preservation.”

Optimizing Fertility Preservation Practices for Adolescent and Young Adult Cancer Patients. J Natl Compr Canc Netw. 2013;11:71-77.

American Society of Clinical Oncology (ASCO):

“As part of education and informed consent before cancer therapy, health care providers (including medical oncologists, radiation oncologists, gynecologic oncologists, urologists, hematologists, pediatric oncologists, and surgeons) should address the possibility of infertility with patients treated during their reproductive years (or with parents or guardians of children) and be prepared to discuss fertility preservation options and/or to refer all potential patients to appropriate reproductive specialists.”

Fertility Preservation for Patients With Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update. J Clin Oncol. 2018; Apr. 5 published online ahead of print. DOI: 10.1200/JCO.2018.78.1914.

Resources to Help

Caseload Benchmarks

No data currently available. Varies widely from program to program.

Insurance Considerations

Oncofertility care services are billed like any other medical service. Bills are submitted to Medicare Part B, private insurance, and Medicaid. One large difference is that fertility preservation services for patients with cancer should be coded under the ‘cancer diagnosis’ as opposed to ‘infertility diagnosis’ as these patients are not yet infertile.

 

ACCC Member Program: Robert H. Lurie Comprehensive Cancer Center

In 2007, the Oncofertility Consortium was established at Northwestern University and developed a strong partnership with the Robert H. Lurie Comprehensive Cancer Center at Northwestern Medicine.  The cancer center provides clinical space to the fertility preservation patient navigator for on-site patient consultation and consenting. The navigator serves as the patient liaison between oncology physicians and reproductive specialists to help patients explore the potential effect of cancer treatment on their fertility, understand available treatment options and provide referrals for appropriate fertility preservation interventions.

Oncofertility Care Team:  Board-certified hematologists/oncologists, radiation oncologists, surgical oncologists, urologists, reproductive endocrinologist and infertility (REI) physicians, PhD-level psychologist, urology and REI fellows, nurse practitioners, patient navigators, social workers, and physician assistants.

Clinic services:

  • Assessment of fertility risk and appropriate referrals
  • Counseling and psychosocial support
  • Fertility education and realistic goals of care discussions
  • Development of a team-based, interdisciplinary care plan
  • Research