By Kirstin Grace-Simons (Madigan Army Medical Center)April 2, 2019
MADIGAN ARMY MEDICAL CENTER, Joint Base Lewis-McChord, Wash. -- Cancer touches all aspects of a person's life. When first diagnosed, starting or expanding a family may not enter a patient's mind. But, for many patients, it's an important topic. Both cancer and many treatments can be destructive for fertility. There is a small window where it can be preserved.
"There are big questions on the table of whether you're going to survive the cancer, building a family is not as much on the forefront of your mind. But, we want to make sure to address it," said Capt. (Dr.) Jessica Lentscher of patients who have just received a cancer diagnosis.
Lentscher is a second year fellow in reproductive endocrinology and infertility at Madigan. She provided Madigan oncology clinicians information on many facets of fertility through cancer in a March 21 presentation.
"About one in eight to as high as one in four couples have infertility issues," said Lentscher.
That's without cancer in the picture.
She shared that one area of oncology care that historically and broadly could use improvement is the occurrence of discussions of fertility risks and preservation options. Lack of familiarity with the options and processes involved, awareness that treatments are not covered by insurance, or simple discomfort with the subject are reasons oncologists are often reluctant to broach the subject with their patients.
This is something Madigan is working to improve.
"We recognize it's an important part of the care that we want to be sure to address with all of our patients," said Lentscher.
To help her colleagues establish greater comfort and a broad familiarity with the subject, Lentscher covered information including: the impacts of cancer and cancer treatments on the reproductive system; procedures used; success rates of different options; safety of fertility treatments; information specific to Madigan patients; the referral process; and financial aspects.
Lentscher walked the audience through the options of extracting and freezing eggs, embryos, ovarian tissue and sperm for use post treatment. She detailed the timelines, procedures and success rates for each.
Ovarian tissue preservation is the only option for girls who are diagnosed with cancer prior to puberty. "It's all experimental," Lentscher said. "Freezing the eggs and the embryos is not. That is routinely done, but the tissue itself is still considered experimental."
Madigan has an agreement with Seattle Reproductive Medicine that allows Madigan patients and providers to use SRM's facilities and care teams for these services.
"Most of our collaboration with SRM is for basic fertility treatments we do and provide to our beneficiaries here," said Lentscher. "Our doctors go to Seattle and use their embryology labs and perform the procedures for our patients," she explained. SRM providers perform these services for the oncology patients.
Most insurance providers are reticent to cover fertility treatment, noted Lentscher. TRICARE currently falls in line with that norm.
SRM, however, is connected with the Livestrong Foundation. This organization supports cancer patients with its fertility discount program that aids in funding treatments. Sarah Thompson, SRM's physician liaison and educator who also offered information at the presentation, said that most patients qualify for financial assistance with Livestrong. SRM also offers all oncology patients a 25 percent discount on fertility services.
When Madigan patients discuss treatment options with their doctors, they are provided a list of facilities. SRM is just one, but it is the only one that Madigan has an agreement with currently.
"They have become a part of the SRM family and we're hoping for success for their patients just as they are. I'm excited to partner with Madigan's oncology team and become a resource for their patients as well," said Thompson of her clinic's collaboration with Madigan.
Lentscher expressed a similar enthusiasm for the success of Madigan's patients.
"It's an honor to have the ability to provide these services to our warfighters," she said.
She is continuing research on ectopic (those that occur outside the uterus) pregnancies and is also at the beginning stages of research on what recent studies suggest are higher infertility rates within the active duty population than with their civilian counterparts.