In Triage Cancer's free Quick Guide to Fertility Preservation, learn what fertility preservation is, options for men, women, children, and adolescents, questions to ask your doctor, costs, your rights, appealing denials of insurance coverage, and more!
Cancer treatment, such as chemotherapy, radiation therapy, or surgery, may affect an individual’s fertility or ability to have biological or genetically-related children. This is called iatrogenic infertility.
Fertility preservation is the process of saving or protecting eggs, sperm, or reproductive tissue so that a person can use them to have children in the future.
If you are interested in becoming a parent in the future, it is important to talk to your health care team before you start your cancer treatment. You should ask about the reproductive risks of your treatment, and about your options for preserving your fertility. Consider consulting a reproductive endocrinologist (women) or a reproductive urologist or andrologist (men). These are doctors who specialize in reproductive medicine and fertility.
| Men & Adolescents | Women & Adolescents | Pediatrics |
|---|---|---|
| Sperm banking | Oocyte (unfertilized egg) cryopreservation | Ovarian or testicular tissue banking |
| Sperm extraction | Embryo (fertilized egg*) cryopreservation | |
| Electroejaculation | Ovarian tissue cryopreservation | |
| Testicular tissue freezing cryopreservation (experimental) | Ovarian shielding – external shields are used to protect the ovaries from scatter radiation | |
| Testicular shielding – external shields are used to try to protect the testes from scatter radiation | Ovarian transposition (oophoropexy) – ovaries are moved away from the line of radiation to try to minimize damage | |
| Hormonal suppression |
*requires partner or donor sperm
| Fertility Preservation Option | Estimated Cost Range |
|---|---|
| Egg Freezing | $10,000-$15,000 + storage fees |
| Embryo Freezing | $10,000-$15,000 + storage fees |
| Ovarian Tissue Freezing | $10,000-$15,000 + storage fees |
| Ovarian Transposition | Unknown |
| Ovarian Suppression | $350-$500 monthly |
| Sperm Banking | $500-$1,000 + storage fees |
| Testicular Sperm Extraction | $6,000-$16,000 |
| Electroejaculation | $10,000-$12,000 |
Because the field of fertility preservation is relatively new and growing, many health insurance companies have argued that fertility preservation is not covered or is experimental.
However, it is important that you understand your rights and your health insurance company’s rules before your start any preservation treatments.
Currently, no federal law requires insurance companies to specifically cover fertility preservation, but some states have passed laws to require coverage, including California, Colorado, Connecticut, Delaware, Illinois, Maine, Maryland, New Hampshire, New Jersey, New York, Rhode Island, and Utah. Texas, Louisiana, Montana, and Kentucky have passed laws to require coverage beginning January 1, 2024. For more information: TriageCancer.org/state-laws/health-insurance-fertility-services. For an up-to-date list of pending legislation, visit: www.allianceforfertilitypreservation.org/advocacy/state-legislation.
If your health insurance company tells you that fertility preservation isn’t covered by your plan, you have the right to appeal their decision. Each insurance company has its own internal appeals process, so contact your insurance company for details or look for instructions on how to file an appeal on your denial letter.
Under the Affordable Care Act, all states are required to also have an external appeals process – this is also sometimes referred to as Independent Medical Review or External Medical Review. For information on your state’s external medical review process contact your state’s insurance agency: TriageCancer.org/StateResources. This process is underutilized, but when people appeal, they are more likely to have their treatment covered by an insurance company.
There is also an option to file an “expedited” or “urgent” external medical review, where a decision must be provided within 72 hours. This faster decision can be helpful for those making fertility preservation decisions before beginning cancer treatment.
When appealing denials of coverage, it is important to argue that fertility preservation for iatrogenic infertility is not “elective” or “experimental,” but rather, a “medical necessity” to prevent infertility. It can also be argued that fertility preservation is a “medically necessary” treatment for a side effect of cancer treatment. Your health care team may be able to help you submit an appeal to your insurance company.
Last updated: 07/2023
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