By Bridget Kelly, Bhakthi Sahgal and Ornsiree Junchaya
What’s more painful: a cancer diagnosis or battling devastating infertility resulting from treatment? For many, it is loss of fertility. Fortunately, newly diagnosed cancer patients in Alabama still have access to fertility preservation services after Gov. Kay Ivey signed a bill last month protecting IVF providers in response to the state’s measures Supreme Court decision that granted legal personality to frozen embryos. While many can now breathe a sigh of relief, it does little to ease the pressure of a hostile reproductive landscape created by legislators who politicize basic human right.
For IVF-relying cancer patients across the country, navigating a minefield of restrictive policies while shouldering a cancer diagnosis is nearly impossible. While Alabama IVF clinics was announced will repeat the proceedings in light of the new law passed, the Court’s decision prompted other states to follow suit with restrictive measures. Legislation has been introduced in 14 states to limit access, with Georgia, Alabama and Missouri enactment of legislation which puts fertility services at risk.
These policies are designed to delay intensive care for patients who often have days to decide whether or not to pursue fertility preservation before starting cancer treatment. The American Cancer Society expects more than 2 million new cancer diagnoses in the US this year. As medical advances continue to improve survival rates, the parallel increase in early-onset cancers among people of reproductive age reinforces the urgent need for access to fertility care. However, due to a lack of federal protections for this vital cancer-related treatment, state legislatures are trampling on patients’ rights to make informed decisions about their survival.
Seventy-five percent of young cancer survivors who have never had children wish to start a family. Oncofertility, the preservation of fertility before cancer treatment, is not just a medical necessity. it is a fundamental right. The American Society of Clinical Oncology and others recommend that oncologists address the risk of infertility and discuss conservation options with their patients. Not only is this conversation consistent with the principles of reproductive rights and informed consent, it is also related with better cancer treatment and improved quality of life for young patients.
The ability of cancer patients to determine the number, timing and spacing of future children is not only affected by these policies, although it certainly does not help. tumorigenicity, as well as other fertility care, is already out of reach for most. According to CDC, the use of assisted reproductive technology (ART), such as IVF, has more than doubled in the past decade. Nearly 100,000 babies are born each year in the US through ART procedures. However, access and availability of these services does not keep pace with demand, with only 1,700 reproductive endocrinologists serving patients in 450 fertility clinics. This access gap is getting worse existing health care disparities– where you live often determines yours access and knowledge fertility preservation options. And then there’s the cost of maintaining fertility. Cost over $30,000 per IVF cycle and usually paid for out of pocket, fertility care is simply not an option for many, particularly those already dealing with the burden of cancer-related expenses.
Currently, 21 states and DC. have passed fertility insurance coverage laws, with 17 of those states mandating fertility preservation coverage for infertility caused by cancer treatments. However, most of these laws it only applies to certain insurers, certain treatments and certain patients. This creates large gaps in financial coverage for necessary cancer-related care. And even for those with insurance coverage, the cost of medication and cryopreservation can still be prohibitive. Moreover, Medicaid coverage is rare, having a disproportionate impact on low-income people and people of color. Only a few states require coverage for infertility diagnostic services, with New York and DC. covering limited cycles of medication.
It is vital that Congress strengthen bipartisan support for the Access to Infertility Treatment and Care Act, requiring all health plans, including Medicaid, to cover infertility treatment. In addition, the Access to the Family Building Act creates federal protections for access to IVF nationwide and the Comprehensive Cancer Survivorship Act ensures Medicaid coverage for fertility preservation for people diagnosed with cancer. Congress should urgently pass these bills to ensure that people newly diagnosed with cancer everywhere have the access they need to comprehensive cancer and reproductive care.
A cancer diagnosis comes with many life-changing and emotional choices. Patients struggling with the dual burden of cancer treatment and fertility loss need look no further bogged down by political debate. Every cancer patient deserves the opportunity to shape their own future, free of ideological views and systemic barriers. The the essence of surviving cancer it’s not just about overcoming illness, but about empowering individuals to make choices that align with their deepest desires and aspirations.
Bridget Kelly, Bhakthi Sahgal, and Ornsiree Juunchaya are Doctor of Public Health students at the Milken Institute School of Public Health at George Washington University researching the intersection of cancer care and reproductive rights.
