Insuring Against Cancer Patients' Infertility

Imagine being a young woman in your 30s. You have just received a diagnosis of breast cancer, as more than 10,000 women your age in the U.S. do every year. Other young women your age may get similarly horrifying news — ovarian cancer, leukemia, non-Hodgkin’s lymphoma.

A cancer diagnosis is bad enough, of course. Then you realize something almost as heartbreaking: The chemotherapy and/or radiation you will get in the next few weeks may well render you infertile, wiping out all or most of the eggs stored in your ovaries since before you were born. Saving your life is paramount, obviously. But saving your fertility is a close second. At least as I see it.

One of the deepest human urges, biologically and psychologically, is to reproduce. It is nothing short of cruel for anyone to deny this hope.

Preservation of fertility in a woman who has cancer should be a no-brainer. Isn’t loss of fertility due to cancer treatment on a par, morally and psychologically, with providing a prosthetic limb for someone who has lost an arm or leg due to injury? Or providing anti-nausea medication for someone undergoing chemo? Loss of fertility in this scenario is a direct result – a legitimate side effect - of medical treatment.

Tragically, that’s not how most insurers see it. Nationwide, “most people don’t get coverage,” Dr. Elizabeth Ginsburg, medical director of assistive reproductive technologies at Brigham and Women’s Hospital, told me.

“Some insurers do, some don’t,” agreed Sean Tipton, director of public affairs for the American Society for Reproductive Medicine.

America’s Health Insurance Plans, the insurers’ industry group, says it doesn’t even collect this data from its members. Gee, I wonder why not?

Thankfully, Massachusetts, as usual, is ahead of the curve. It is one of 15 states with laws requiring insurance coverage for infertility treatment in general.

But here’s the catch. Even in states like Massachusetts where infertility in general is covered, many young women faced with a cancer diagnosis are so young that they are still fertile. So they don’t qualify as “infertile,” which is usually defined as a woman of any age who has been trying unsuccessfully for over a year to conceive or a woman over 35 who has tried unsuccessfully for six months.

Isn’t loss of fertility due to cancer treatment on a par with providing a prosthetic limb for someone who has lost an arm or leg due to injury?

A couple of insurers based in Massachusetts do have the heart to pay before cancer treatment begins, for one cycle of ovarian hyperstimulation (to help a woman produce more eggs), retrieval of the eggs and freezing of either the eggs or the fertilized embryos if she has a male partner with whom she wants to have a baby. After cancer treatment is over, fertilized embryos can be implanted in hopes of producing a pregnancy. The whole process costs around $12,000.

Until recently, the “official” reason insurers nationwide gave for not covering egg freezing (as opposed to embryo freezing) is that it is “experimental,” fertility specialist Drew Tortoriello of the Sher Institute told me.

But that rationale is history now that the American Society for Reproductive Medicine announced last month that egg freezing should not be considered “experimental” because there is now enough data to show that the technique is reliable for use when medically indicated. (Medical indications include impending loss of fertility due to cancer treatment.)

It’s clear that many young women faced with both cancer and infertility desperately want to preserve their ability to have children. In one 2004 study of young women with breast cancer, 57 percent recalled having substantial concern at diagnosis about infertility after treatment, and many said this concern influenced their treatment decisions.

“This was eye-opening for medical oncologists because they were so focused on the cancer,” said the lead author of that study, Ann Partridge, director of the Adult Survivorship Program at Dana-Farber Cancer Institute.

Frankly, it shouldn’t be all that eye-opening to doctors or insurers. One of the deepest human urges, biologically and psychologically, is to reproduce. It is nothing short of cruel for anyone to deny this hope.

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