On May 17, Congresswoman Rosa DeLauro (CT-03) and Senators Cory Booker (D-NJ) and Bob Menendez (D-NJ) introduced the Access to Infertility Treatment and Care Act (HR 2803 and S 1461). ASCO has endorsed this bill, which would require all health plans offered on the group and individual markets—including the Federal Employees Health Benefits Program, TRICARE, the Department of Veterans Affairs (VA), and Medicaid—to provide coverage for the treatment of infertility without raising insurance or copayment costs. In addition, the bill would require coverage for fertility preservation services for individuals who undergo a medically necessary procedure that may cause infertility, such as chemotherapy or radiation.
According to the Centers for Disease Control and Prevention, approximately 12% of women aged 15 to 44 years in the United States have difficulty getting pregnant or carrying a pregnancy to term, and in approximately 35% of couples with infertility, a male factor is identified along with a female factor.[i] For cancer survivors who were treated as children, this issue is particularly relevant. The survival rate for common cancers among children is greater than 80%, resulting in the fact that one of every 250 adults today is a childhood cancer survivor. And surveys indicate that more than 75% of these young cancer survivors would like to have children in the future.[ii]
However, despite the one in eight couples facing infertility whether from past cancer treatment or other medical issues, treatment options are not widely covered by insurance. A press release issued about the bill noted that, “A 2017 survey found that nearly half of employers with at least 500 employees did not cover infertility services, and 25 percent of companies with 20,000 or more employees also did not cover such services.”
ASCO believes fertility preservation coverage is a crucial step in improving the quality of care for patients with cancer. The Society advocates for coverage of embryo, oocyte, and sperm cryopreservation procedures for patients who have been diagnosed with cancer but who have not started cancer treatment, including chemotherapy, biotherapy, or radiation therapy treatment.
ASCO issued its first guideline on fertility preservation in 2006 and updated it last year. The guideline, “Fertility Preservation in Patients With Cancer,” includes suggestions that health care providers should:
- Discuss the possibility of infertility with patients receiving cancer treatments during their reproductive years or with parents/guardians of children as early as possible.
- Be prepared to discuss fertility preservation options and/or to refer all potential patients to appropriate reproductive specialists.
- Advise patients regarding potential threats to fertility as early as possible in the treatment process and document the discussion. This allows for the widest array of options for fertility preservation.
The Society looks forward to working with the sponsors of the Access to Infertility Treatment and Care Act as it moves forward.
[i] Centers for Disease Control and Prevention. “Infertility FAQs.” https://www.cdc.gov/reproductivehealth/infertility/index.htm. Accessed May 21, 2019.
[ii] National Comprehensive Cancer Network. “Cancer and Fertility.” https://www.nccn.org/patients/resources/life_with_cancer/fertility.aspx. Accessed May 23, 2019.