Triaging Fertility Preservation & the AMA

This post addresses a recent advancement in the the issue of insurance coverage for fertility preservation.  We first highlighted this issue in the post Insuring Against Infertility.

by Raphael Yechieli, M.D.
Caduceus with First-aid Kit

The American Medical Association (AMA) just adopted a new policy supporting coverage of fertility preservation for cancer patients. This is a big deal. A recent study from California highlighted that only 2 – 4% of women eligible for fertility preservation actually underwent the process. The guidelines from the National Comprehensive Cancer Network and the American Society of Clinical Oncology are both unequivocal. Infertility as a side effect of treatment must be spoken about and fertility preservation should be offered to anyone whose fertility may be compromised by the treatment being offered. Alas, we can shout from the rooftops about the importance of fertility preservation, but without routine insurance coverage, these guidelines will be an impracticable recommendation.

Over 150,000 people under the age of 45 will be diagnosed with cancer this year. Treatments continue to improve, and long-term survival is becoming the norm; but many carry their battle scars long after the war is won. With a renewed focus on survivorship, the quality-of-life and healthcare issues that arise after treatment are now recognized as an important part of the cure. One particularly difficult side-effect of some cancer treatments is their effect on fertility. The same features that allow these treatments to be so effective in treating the cancer are what make them so harmful to the person’s future fertility.

Benjamin Franklin said “An ounce of prevention is worth a pound of cure.” Regarding fertility after cancer treatment, the more appropriate saying is “An ounce of prevention is the only cure.”  Fertility preservation prior to treatment is the best way to protect a person’s ability to have children in the future. The options available for survivors, especially women, have previously been limited. This is changing, with the emergence over the past few years of oncofertility, an interdisciplinary field founded at the junction of cancer and fertility. The advances in research and development are very exciting, and will provide people with options that were impossible just a few years ago.

Since 1998, the federal Women’s Health and Cancer Rights Act (WHRCA) mandates that insurers cover breast reconstruction if they covered the mastectomy. In fact, treatment of almost every side-effect from cancer treatment is covered by insurance, except for fertility preservation. Even in states with mandated infertility coverage, fertility preservation is not covered, because the person has yet to be diagnosed with infertility!

Last week, a very important step was taken. The Michigan delegation to the AMA presented Resolution 114, asking the AMA to support payment for and lobby for appropriate federal legislation requiring coverage for fertility preservation when cancer treatments may cause infertility. After hearing impassioned testimony from the Michigan delegation and multiple other delegations including medical groups at the intersection on cancer and fertility, the resolution was accepted by the AMA.

The advocacy will continue on the state and federal level. Currently, a bill is working its way through the California legislature, and similar bills are being prepared in other states as well. We will continue to work, one step at a time, to make sure that every person gets the care they need.

Raphael Yechieli M.D. is currently the chief resident of Radiation Oncology at Henry Ford Hospital in Detroit MI and a delegate to the AMA from the Michigan State Medical Society’s Resident and Fellow Section. He is passionate about survivorship and advocacy, and spends his time working together with his team to build hope, and destroy cancer. 

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