Fertility Preservation for Iatrogenic Infertility: Patient Barriers and Opportunities for the Reproductive Medicine Workforce

Iatrogenic infertility can result from medically necessary treatments that reduce fertility potential such as gonadotoxic chemotherapy and radiation but also brain and pelvic surgery, biologics for autoimmune disease, and hormone therapy. Fertility preservation (FP) involves freezing embryos, oocytes, ovarian tissue, sperm, or testicular tissue for future procreation and may be the only option for some patients who hope to use their autologous gametes for future reproduction. Although there is a growing awareness to refer patients at risk for iatrogenic infertility to reproductive specialists, patients seeking FP continue to face a multitude of barriers. The most prohibitive factor is cost, but poor accessibility to specialty care, lack of education of providers and patients, and stigmatization around reproductive health may all lead to delayed referrals. We discuss several opportunities for the reproductive medicine workforce to help address barriers to FP. One method to make FP more accessible to patients in a shorter time frame would be to make it more affordable through improved insurance coverage. Currently, there is no active federal legislation mandating that insurance plans cover FP; however, there have been several success stories at the state level. In addition, education of providers and patients through multispecialty collaboration and targeted campaigns can have a profound impact on expediting referral for fertility care. Promising new technologies and innovation in health care delivery are also on the horizon. Unaddressed fertility concerns are very distressing to patients and detrimental to their quality of life. Urologists can contribute significantly to improving the care for these patients clinically and through advocacy and education.