More and more people are being diagnosed with cancer in their 20s and 30s. At the same time, more people are delaying having children until their 30s and 40s. So what happens to a young person’s plans for children after receiving a cancer diagnosis?
As a doctor working in oncology, I deal with this question frequently. Many cancer treatments, like chemotherapy and radiation, can leave patients infertile. For young people with cancer who want children, we recommend fertility preservation procedures, such as egg freezing or sperm banking, prior to starting cancer treatments. These procedures are also helpful for people with non-cancer medical conditions that impact fertility, like endometriosis and certain autoimmune disorders.
Fertility preservation procedures are not cheap. The cost for one cycle of egg freezing can range between $5,000 to $15,000, with storage costs for sperm and eggs between $500 to $1,000 annually. For a young person facing a surprise diagnosis of cancer and a looming deadline — the urgent start of cancer treatment — being able to pay this price may be impossible.
Six years ago, the Connecticut state legislature passed a bill mandating all private health insurers to cover fertility preservation procedures for people diagnosed with cancer. This law is a blessing for some, but it leaves out people with public Medicaid insurance and creates a huge inequity in access to medical care.
I cared for a 29-year-old nurse who was diagnosed with breast cancer and needed chemotherapy prior to surgery. Two days after our first meeting, she saw a reproductive endocrinology specialist and made plans to freeze her eggs. Her employer-sponsored health insurance covered most of the cost. She was understandably distressed about her cancer diagnosis, but thankful to have some hope and control over her desire to become a mother in the future.
Not too long after, I cared for a 22-year-old male student who was unexpectedly diagnosed with acute leukemia. I spoke to him about sperm banking, which is a much quicker and less invasive procedure than egg freezing. But his public Medicaid insurance covered none of the cost. He would have needed to arrange upwards of $1,000 within one day prior to starting emergent leukemia treatment. He could not afford this amount in this short a time, so he moved ahead with chemotherapy treatment, leaving behind his future dreams of having a family.
This inequity represents a huge shortcoming in our medical healthcare system. Recommending fertility preservation is the standard of care. Like all oncologists, I discuss these procedures with my patients before starting treatments that might make them infertile. But in real life, some people cannot access these procedures because of their insurance type. They are financially forced to accept sub-standard care.
Thankfully, there is a proposed Connecticut state bill that would correct this inequity. House Bill 6617: “An act to promote equity in coverage for fertility healthcare” would mandate state Medicaid to cover fertility preservation procedures for patients with cancer and other medical conditions that compromise fertility. This bill has passed out of both the Human Services Committee and the Appropriations Committee and needs to be voted on by the full legislature by June 7.
To be sure, some may be concerned about how much this bill may cost the state budget. One positive note is that for all Medicaid expenses related to reproductive health, the federal government covers 90% of the cost, while the state is responsible for only 10%. When this cost-sharing split — 90% federal and 10% state — is combined with the relatively low numbers of Connecticut residents who may face this need — around 600 people — the impact on the state’s budget is minimal.
Others may claim that fertility preservation is an elective procedure, not a necessary one. But there is nothing elective about a cancer diagnosis and preparing for life around cancer. Other elements of cancer care, including wigs, reconstructive surgery, and anti-nausea medications are covered by all types of insurance and not considered “elective.” Neither is fertility preservation.
An unexpected cancer diagnosis can happen to any one of us without warning. Everyone, regardless of insurance, should be able to access the complete standard of care for cancer treatment. Will you help pass HB 6617 into law? Please email or call your state legislators and ask them to pass HB 6617. Ask them to ensure that young people in Connecticut who face cancer can also hope for a future family.
Norin Ansari MD MPH practices at Yale New Haven Hospital.