Welcome, everyone, to this episode of the SART Fertility Expert Podcast. I am Dr. Josh Halpern. I am a reproductive urologist, currently serving as the Chief Scientific Officer at Posterity Health, and I'm really excited to host today's podcast, where we're talking about oncofertility and fertility preservation, really that intersection between cancer care and fertility care.
And I'm joined today by a number of really outstanding colleagues, experts, friends, and I've really been looking forward to this discussion. So I want to start by just introducing our crew for today, and then we'll get right into it. So we have Dr. Irene Su, who is a professor of reproductive endocrinology and infertility at UC San Diego.
She's also the fellowship director for REI there. Among her many other hats, she is co-director of the Center for Obstetrics and Gynecology Research Innovation, and has done maybe dozens and dozens of other outstanding leadership roles and positions over the years. But perhaps most importantly, she's really a thought leader in the field of oncofertility.
So really excited to have her here. Irene, thanks for joining us. Thank you so much for having me.
This is going to be fun. Joined by Dr. Su is Dr. Carissa Pekny, who is also at UCSD. She's currently a second year reproductive endocrinology fellow, and she has already had an interest in oncofertility and fertility preservation.
Really excited, you know, about the work that you've done in kind of thinking about fertility preservation in the military, and excited to hear your comments today. So thanks, Dr. Pekny, for joining us. Super excited to be here.
Thanks for having me. Last but not least, Dr. Deebel, who, you know, I've known for quite a while. Dr. Nick Deebel is a reproductive urologist who actually has just joined the faculty at the University of South Alabama.
And he also, in his early career, has done a good amount of work in the space of fertility preservation, both in the oncologic space, the non-oncologic space. And he has just completed Reproductive Urology Fellowship at Northwestern University, which has really been kind of the epicenter in many ways for oncofertility care. So Nick, thanks for joining us as well.
Of course, thank you for having me. This is a topic I'm very passionate about and happy to share it with you guys. Great.
So really excited to have all of you here. And I want to get started with Dr. Suh. You have seen this field evolve and really grow in a lot of ways over time.
Can you just start by telling us a little bit, what is oncofertility? Tell us about the term itself, how it was coined and kind of what it means to you and what it should mean to everybody listening. Yeah, it's hard to imagine that oncofertility was such a new discipline, you know, oh, close to maybe almost two decades now. Oncofertility exists at the intersection of oncology and fertility.
And it really grew from understanding that people who are young and diagnosed with cancer are going to undergo treatments that may harm their ability to have, build the family that they want or hurt their hormone health in the future. And so at the same time, in fertility and reproductive technologies, there became advances that helps to prevent some of these adverse fertility and reproductive health outcomes. And so oncofertility care really exists at that intersection of counseling young people who are diagnosed with cancer about their potential reproductive risks and then offering them the opportunity to leverage existing technology to preserve future fertility and reproductive health.
That's an outstanding kind of unpacking of oncofertility. And it is amazing that we are really still in the infancy of this field and yet so much has developed over a short period of time. I want to unpack a little bit what you mentioned as far as the threat to cancer when it comes to fertility.
Can we talk a little bit about kind of how cancer and its treatments impact fertility? Because I think that's really important to kind of drill down on and the ways are myriad, right? So to understand how cancer can impact female fertility, I think you have to understand a little bit about underlying fertility. And so for a female to be able to have a healthy baby, they need to have eggs. And the number of eggs in each female is pretty limited.
And some cancer treatments, not all cancer treatments, can destroy the limited number of eggs women have for their lifetime. So that's one way in which cancer treatment could impact the future ability to have children. The second way is that sometimes cancer treatments also affect other organs in our bodies.
For example, someone with uterine cancer may need their uterus removed. Right. And so even though that's not directly harming the eggs, that person becomes infertile because there's no longer the ability to carry their baby.
And then finally, because some cancer treatments have other systemic late effects. So if affects our lungs, our ability to sort of breathe normally, those are all going to be risks on a mom on their perinatal health. And then finally, even when cancer treatment does not directly ablate the number of eggs that females have, if you have to be on prolonged treatment.
So an example is going to be hormone therapy for breast cancer patients for five to 10 years. Then we're also aging during that time. And our fertility, of course, decreases as female age increases.
So to me, there's really three or four ways in which cancer treatments can directly harm future fertility for females. That's super helpful. One of the other things that I think about a lot when it comes to cancer and fertility, at least on the male side, and I know this applies on the female side to a large extent as well, is even upstream of the cancer treatments, some of the effects of cancer itself.
So we know that a lot of these men are presenting, for example, with B symptoms, right? They have super high fevers, for example, depending on their cancer. Sometimes that in and of itself can cause systemic effects, impact sperm production. We know sometimes those hormone abnormalities that you mentioned that can ensue from the cancer treatment, sometimes they're inherent to the cancers themselves.
We see this in things like testicular cancers and, you know, perineoplastic syndrome sometimes and things like that. So I think everything you talked about on the egg side of things holds super true on the sperm side of things, whether it's radiation, whether it's surgery to have a testicle removed, whether it's systemic therapy, all of these things can really threaten kind of fertility both now and in the future. Yeah, I think that's the same on the female side in terms of when you see reproductive age people who are maybe childhood cancer survivors and you look at the health of their offspring because our patients often ask us, is my baby going to be OK? If I can see them post cancer treatment in a large part, it's reassuring.
Sometimes there's a little bit higher risk of preterm delivery, but otherwise there generally is no higher risks of, for example, birth defects or low birth weight or things like this. So that's reassuring news for female cancer survivors. Yeah, I think that's a really great point.
And that's a really nice segue into thinking about, you know, kind of fertility preservation here, which is a big part of our topic for today. And before we get into fertility preservation, specifically when we think about kind of the sperm side and the egg side, I would love for you to kind of just tell us broadly about fertility preservation as a concept, how that kind of dovetails with oncofertility and how you think about fertility preservation. Yeah, so fertility preservation is really thinking about are there procedures, medications and such that can help us prevent the adverse sequelae or what cancer or cancer treatments can do to the ability to have children after cancer? So that's a lot of words to say that for females, there are a number of established fertility preservation procedures ahead of a cancer treatment.
For example, freezing eggs, freezing embryos. In some situations that we'll kind of talk about in a bit, for example, freezing ovarian tissue prior to cancer treatment. And there's some new developments that are exciting on the female side in terms of there's the opportunity to, again, freeze eggs or embryos post-treatment.
Similarly, on the male side, right, freezing sperm or testicular tissue ahead of cancer treatment. And it is so critical because there are cancer treatments that we know harms the ability for us to make sperm or make eggs post-treatment. And so if for a young cancer patient, their goal is to have the choice of having children biologically related to themselves in the future, then undergoing these services prior to the start of treatment becomes a super important opportunity to preserve that future goal.
Yeah, I think that was really well said. One of the other ways that I tend to think about this is with respect to the evolution of cancer treatments and how good we've gotten at treating cancer. So a lot of the diseases that we used to see decades ago were diseases that at the time were fatal.
And so a lot of the oncologists, a lot of the medical community was really focused on curing disease and not thinking about life after disease. But fortunately, when you look at all of these cancers that we see, or at least a lot of them that we see in young men and women of reproductive age, our survival rates have really gotten very, very high. And so it's really incumbent upon us to think not just about the patients with respect to their cancer diagnosis and their disease now, but thinking about their quality of life in the long term and family building is such a huge part of that.
So I think fertility preservation is so important. And with that, I'd really like to turn it over to you and Dr. Pekny to talk specifically about fertility preservation on the egg side of things. And then we'll have a parallel conversation with Dr. Deebel about the sperm side of things.
Great. All right, Dr. Pekny, could I start by asking you, you know, when a person, a woman is of reproductive age and that they're newly diagnosed with cancer, what does that timeline look like for a fertility preservation consult? You know, I think we'll tell you we'll see you whenever the best time to see you is before treatment has started, because that gives us the opportunity to really talk about all options. There's a lot of different types of treatments that people undergo, and the time sensitivity of that can vary.
The American Society for Clinical Oncology tells us basically a diagnosis and then readdressing those needs during survivorship is important. So anybody that's uncertain about doing fertility preservation or definitely knows they want to do it, we're happy to talk to anybody and everybody in between as reproductive endocrinologists. Dr. Pekny, could I also ask you, why is it so time urgent? Because the timing of cancer treatment sometimes is outside of the patient's control.
So we would love to have the opportunity of time, but sometimes the treatment for cancer can't wait, which sometimes constrains what we're able to do from the fertility preservation standpoint. But it still allows us to talk about options and also follow up for the patient, even if we're not able to do ovarian tissue cryopreservation or preserve oocytes or embryos too. Currently, what do we know are established standard of care fertility preservation treatments in women? So oocyte cryopreservation, so freezing eggs, is an option for people who don't have a partner or don't want to use donor sperm or want the option to fertilize those eggs later.
Embryo cryopreservation, so fertilizing those eggs, is an option for people who've undergone puberty, who are able to undergo that ovarian stimulation process, and who have a partner or want to use donor sperm. So eggs are retrieved, fertilized, and the embryos are frozen for future use. Or ovarian tissue cryopreservation, which the experimental label was taken off in 2019 and lots of good data out of Europe from live births after that, that's for people who haven't undergone puberty or have time constraints that wouldn't allow them to undergo that two to three weeks of IVF stimulation.
We also have other sort of less common things. So people that get radiation in the pelvis during ovarian transposition, so physically kind of stitching the ovaries outside of that radiation era, fertility sparing surgery for certain cancers where their ovaries don't need to be removed, or giving somebody a GnRH agonist medication like Lupron for ovarian suppression during chemotherapy in select populations. What happens, what are the common questions that patients ask you when they're considering, they're asking you, Dr. Pekny, what should I be worried about? What should I be asking about when I'm thinking about these fertility preservation options? So there are some considerations, patient's age, so how old are they now? How many eggs do we currently think that they have? Have they undergone puberty? So those patients that are a little bit younger when they're diagnosed with cancer, whether or not they've gone through puberty allows us to either freeze ovarian tissue if they haven't or to undergo this IVF stimulation process if they have.
Their diagnosis, we've talked about a lot of things that might be attributed to the cancer symptoms. Is it safe for people to undergo the stimulation for IVF? And really, it's not just doing the shots to stimulate the ovaries. It's also the retrieval procedure that we need to do at the end, which we have to make sure the patient's safe undergoing anesthesia to allow us to actually get the eggs as well.
In this fertility preservation space, in terms of the technology that's being developed, what are you excited about for the future? I am super excited at the amount of options there are for people. I think this experimental label was taken off of ovarian tissue cryopreservation in 2019, and there are a lot more centers that are actually offering this throughout the United States. So people that didn't undergo puberty actually have the ability to maybe have options for future fertility later.
I know our center at UCSD does it and a lot of other people around the country do too. Well, that's a really great discussion, really gives us an opportunity to pivot here and talk about fertility preservation on the sperm side of things. And, you know, it's a little bit funny, but also true that when it comes to sperm and fertility preservation, it's in many ways like guys are just easier, right? And really standard of care when it comes to fertility preservation on the sperm side of things is cryopreservation of sperm through an ejaculated sample.
So, Dr. Deeble, tell us a little bit about the process of fertility preservation when it comes to producing an ejaculated sample. Talk about some of the timeline considerations that Dr. Pekny talked about, what this looks like for a patient with a new cancer diagnosis and, you know, what are some of the hurdles in fertility preservation for these guys? Sure. So, you know, as you mentioned, Dr. Halpern, you know, on the male side of things, sperm cryopreservation really is the foundation of fertility preservation for our patients.
And, you know, in terms of a timeline, you know, when the patient is diagnosed with a malignancy or various cancers, they are going to, in an ideal world, produce an ejaculated sample, ideally with about two to three days of absence ahead of time. And then that semen sample is frozen using what we call a cryoprotectant, which is a material that protects the sperm as it's frozen. It's loaded into what we either call like straws or vials using a rate controlled method that keeps the sperm safe.
In terms of the ideal timeline, as, you know, Dr. Su and Dr. Pekny had mentioned too, sooner is better, right? So when we, you know, when a patient provides an ejaculated specimen, depending on the analysis of that specimen and the amount of sperm that are found, the lab is usually able to partition that into various vials. However, the more vials, the better, because when patients go to use this afterwards in the future, you know, once you thaw a vial out, you cannot refreeze it. So the more vials they have, the more chances they have at use in the future.
That's helpful. And how would somebody who froze sperm in these vials, how would they go about using that sperm in the future? What does that process look like? How long can sperm remain stored in these vials? Is there a shelf life? Tell us a little bit about that. Sure.
These are all really great questions. And these are questions, you know, we discuss with patients every single day in our clinics. So cryopreserved sperm is very stable.
We have patients using their frozen sperm decades later. So we've had patients that, you know, froze sperm when they were adolescents and then come back when they're in their late 30s and 40s and are using the sperm successfully. So the good news is that if sperm is frozen in time, it is very durable and it stays healthy, you know, when thawed even decades later.
In terms of, you know, your other point. So a question we get a lot is when patients are ready to use their sperm in the future, how would it be used? And typically our answer for patients is that this would be used for in vitro fertilization with what we call intracytoplasmic sperm injection or ICSI is the abbreviation. And this is where sperm is injected directly into the egg and used for in vitro fertilization.
We get asked frequently if this sperm can be used for what's called intrauterine insemination. And the practical realistic answer is no. And the reason why is in order for intrauterine insemination to be successful, we rely on having large numbers of sperm.
And the problem with using cryopreserved sperm for IUI is anytime you thaw the sperm, we know that you lose about 50 percent of sperm post thaw. And we worry additionally that, you know, patients are going to burn through their entire supply of frozen sperm with one IUI cycle and not have a success. So we typically counsel patients for that reason that this is intended to be used for IVF.
Yeah, that's a really, really helpful overview of freezing sperm, how you might use it. I think the shelf life is really important. There's a lot of really good data showing that you can use sperm decades later and still have really good outcomes when it comes to recovering sperm and not just recovering sperm, but outcomes with an IVF cycle.
So I think we can provide great reassurance to patients in that regard. Obviously, freezing sperm, as we've talked about with an ejaculated sample, is in many ways easier than oocyte cryopreservation. We don't need to stimulate patients typically, you know, with any hormonal protocol.
But there are definitely some situations where a man can't produce a semen sample or they produce a semen sample and there's no sperm. So tell us a little bit about what some of those situations and scenarios might be and how the patient and their care team might navigate those scenarios. What are the alternative treatment options that you might employ when somebody can't produce a sample? You know, I think in reproductive urology, we like to at face value a lot of times think that, you know, providing a semen specimen is easy for the patients and something that should be able to be done without that much difficulty.
However, there are quite a bit of situations in where, you know, a semen sample can't be reliably provided or just frankly, one's not available. This is multifactorial in nature. So sometimes this can be difficulty producing a specimen due to anxiety, acute illness, or potentially, depending on the nature of their illness, they have a neurologic reason as to why they cannot produce a specimen.
So common example would be, you know, testis cancer patients who have had surgery, you know, a surgery called a retroperitoneal lymph node dissection. Those patients may actually have difficulty with producing a specimen or, you know, Dr. Halpern, you alluded to this before, you know, a common situation we see, you know, and we saw during my fellowship at Northwestern is, you know, a lot of patients were getting consults for fertility preservation when they're acutely very ill. Right.
So patients who are admitted in the hospital who are, you know, very, very sick and they're either unable to produce a specimen or because of the nature of their acute illness, they have very poor specimens, either severely oligospermic, which means very few sperm identified, or even sometimes they're asospermic, which means they have no sperm identified. So we have additional options that we talk to patients about, you know, if there's a suspected neurologic reason as to why they're unable to ejaculate, there are procedures ranging from penile vibratory stimulation to a procedure called electro ejaculation, which can be done. These are ways to interact with the nervous system and produce an involuntary specimen that can then be used.
We have patients with certain cancers that leave them with a process called retrograde ejaculation, which means that, you know, even though they produce an ejaculate, it's not actually being emitted out of their urethra or their penis. Sometimes that specimen can be harvested from a urine specimen and then alkalinized, which means protected with a basic solution and then stored. Or, you know, a common solution or excuse me, a common situation we see are patients who are acutely ill and unable to provide a specimen or have no sperm available.
We then can talk to them about going to the testicle or the epididymis through a surgical procedure called a TESE or a MESA, and those sperm can be surgically extracted and frozen from there. Yes, a lot of contingencies, right? I mean, in the end of the day, of course, you know, producing a semen sample through masturbation ejaculation is is always going to be our preferred option. But there's so many situations when you may not be able to do that.
And I think one of the things I just want to really focus in on what you mentioned is that it's really hard to produce a semen sample, obtain an erection, ejaculate when you're in a lot of pain, when you're very sick. And sometimes that's really that's really overlooked. So somebody who's acutely ill in the hospital, they're just not going to be up to the task.
And so we've got these other methods, whether it's penile vibratory stimulation, sometimes testicular sperm extraction, whatever the case may be. One of the questions that we get asked a lot, which I think is one of the hardest clinical scenarios that we as reproductive urologists face is the patient who has already started chemotherapy and is coming to see you to talk about fertility preservation. So we already heard from Dr. Su, I think, in a really articulate way how chemotherapy threatens not just the gametes themselves, so, you know, the oocytes in the sperm, but also just the quality and the potential risks of using those those gametes, even if they survive.
How do you think about that patient that's come to see you after having had, let's say, an initial dose of systemic chemotherapy, something that's, let's say, platinum based and is coming to you and saying, Dr. Deebel, you know, I really do want to preserve my fertility before I get any more chemotherapy. Is it possible for me to produce a semen sample and freeze? And what are the risks of doing it? Sure. So, you know, I think this is a question we're faced with quite frequently.
And unfortunately, I wish it was less frequently. But, you know, a lot of our a lot of concerns that were brought up by Dr. Su are mirrored in our clinics. You know, the short answer is, yes, you can produce a specimen and freeze it.
However, we have a lot of trepidation and a lot of concern about using that specimen because, you know, as you mentioned, some of the chemotherapy agents that are commonly used, such as platinum based agents, you know, they affect the stem cells that are actively turning over and producing sperm. And we know that the process of spermatogenesis is about 67 to 70 days. So even once they've had that hit, if you will, of chemotherapy, it's going to affect their kind of entire testicular environment and their ability for the stem cells to turn over and make healthy sperm.
We do worry about, you know, DNA fragmentation. We worry about epigenetic changes to the DNA that's going to be in the sperm. So we typically do not advise patients to, if they've already started therapy, freeze the sperm and use that sperm for future fertility efforts because, you know, there is a risk of affecting the offspring.
Yeah, this is just one of the trickiest clinical scenarios that we run into. And it's really hard to counsel these patients, but it probably is not safe to use those sperm. On the other hand, as they move along with their chemotherapy or whatever their treatment may be, we know that there's going to be even greater assault on their ability to make sperm.
And they might be in a position where they have just a few sperm now, but they might not have any sperm a few months from now. And so I think really important to have thoughtful discussion as a patient with your provider, with your team, understand those risks, understand what the options look like. We heard from Dr. Pekny about some of the exciting treatments that are kind of in development on the egg side of things.
Dr. Deebel, what are you excited about on the sperm side of things? Because there's actually, in my mind, a lot to get excited about. I agree. So I was very fortunate enough to, you know, during my residency time, I did a lot of basic science research in some of the male fertility preservation space.
And I can tell you that, you know, while we're not quite ready for prime time, there's a lot coming down the pipeline that I think we have a lot of reason to be excited about. And one of the biggest areas in my mind is what we, you know, refer to as spermatogonial stem cell banking as one of the most transformative frontiers. So, you know, differently from our female patients, right? Pre-pubertal boys, they don't, you know, start producing sperm until they undergo puberty.
And so we have lots of, you know, pre-pubertal and peripubertal patients with, you know, childhood cancers, and they haven't even had a chance—their body hasn't had a chance to produce sperm yet. So what do we offer those patients for preservation? And, you know, currently, and for the past few decades, the answer has really been, unfortunately, not that much. However, there's a lot of experimental protocols out there and a lot of really exciting work being done about spermatogonial stem cell banking and engineering.
So essentially what this means is, you know, a pediatric patient would have a sample of testicular tissue harvested, and the spermatogonial stem cells, which are the stem cells that give way to mature sperm, are cryopreserved, and we're finding a way to push these stem cells to turn into sperm, put simply, in the lab, with the thought that these sperm could then be used for, you know, fertility efforts down the road. Alternatively, people are looking at harvesting these spermatogonial stem cells and retransplanting them back to the testicular environment for patients once they're on the other side of their cancer treatment. There's a lot of companies actively working on these spaces with pretty promising results.
You know, however, we're not quite at primetime yet. Yeah, I think a ton of progress has been made. And while we're not at primetime, even, you know, as recently as about a month or two ago, there was a study out of Europe where they employed one of these strategies where they had taken testicular tissue from a pre-pubertal young boy, and now about 16 years later, we're able to grab that back into his body, and we're able to extract sperm from it.
And that's hot off the press. And so something that was, I think, truly inconceivable not too long ago is getting closer and closer to the clinical domain. So I think there's a lot to be excited about here, both on the egg and the sperm side of things.
So, you know, I want to just kind of wrap up this portion of the discussion. I think just to summarize what we've talked about, we've got a great overview of oncofertility and fertility preservation. And I think just to be super clear, fertility preservation, or at least a discussion of fertility preservation, is standard of care.
And Dr. Pekny mentioned, you know, the ASCO guidelines, the American Society of Reproductive Medicine guidelines, you know, all recommend that any new patient, any patient with a new cancer diagnosis really should have a conversation around their fertility because of everything that we're talking about, because of the threat that cancer is going to pose, that cancer treatments are going to pose to fertility. And we've got some really well-established tried and true methods to employ that fertility preservation. One of the other issues we see around fertility preservation is not necessarily what we can do for patients, but how patients can access these treatments.
What are the barriers to care when it comes to fertility preservation? And Dr. Su, I would love for you to kind of talk a little bit about this. You have done so much great work in this area. You've seen this from every angle, and it's impossible to be comprehensive here.
But where do you see the barriers in fertility preservation in employing these treatments and getting patients in? Yeah, it's eye-opening because I think the concept that there's medically effective ways to preserve fertility for the future and that patients don't, can't access it, it's like deeply, it's so deeply challenging to those of us who are clinicians. And so, we and others really wanted to boil it down to four places where this process becomes broken. The first is that not every new patient who is diagnosed with cancer actually gets screened about what their reproductive goals are and counseled about their reproductive risks.
Then even if they are counseled, that handoff, that warm handoff between oncology and fertility is one that's fragmented, but there are ways to approach that systematically. Even when people get to the fertility specialist, whether male or female, it turns out that these procedures are often not covered by insurance and unaffordable by our young patients in the moment. For example, out-of-pocket cost for freezing sperm is what, $500, $600 at least.
And not everybody has that kind of in their pocket ready to go. And egg freezing is what, $10,000 before medications. So, there are basically to us, these four barriers and whether they're screening, then once you're screened on your oncologist's office, whether you're referred from oncology to fertility, you can actually get to the fertility person.
And then even at the fertility person, assuming that you are someone who's safe to undergo fertility preservation, can you still, can you afford it and how can we help you to get there? Yeah. And this is also a question that I don't think can be answered in one breath. But what are some of the things that you've seen both clinically and then in an academic space from a research perspective that have been most successful in overcoming some of these barriers? And there are so many interventions we've looked at.
I think on our side of things, on the sperm side of things, certainly male and cryopreservation, lowering the cost, providing access for folks who are in geographic areas that are remote from a laboratory, some of the telehealth, some of the legislative efforts to provide that financial coverage that you mentioned is so necessary. What are the things that you think have made the biggest differences? Yeah. I'm so excited about the technology that enables male and sperm freezing.
So good on all those people who've made that possible. I think big strokes are that we need systematic interventions and health systems. So if oncology systems can prepare for our youngest patients by making sure that there is a clear pathway to screening and getting from oncology to fertility, that preparing for the patient who's going to walk through the door, that's huge.
That can be done with help from, for example, electronic health record system nudges. What you talked about has been super exciting with regard to health policies, really mandating that fertility preservation procedures are covered as a part of our health insurance coverage. There's currently, really since 2017, in a very short period of time, we've got 21 states in the District of Columbia that have passed these mandates requiring some health insurances to cover fertility preservation in the setting of cancer, for example.
Lots of concerns about the downstream implementation of that, but we and others are working on how do you, once we're all super excited that a law is passed, what is it that we need so that that law reaches the patient? And I know that Dr. Pekny and others on our team spend a lot of time thinking about this. Dr. Pekny, what am I missing? What are the other big hammers that are going to make a difference for our patients? Yeah, I think so much of it is the multidisciplinary aspect of it. I think we are not the only people in this process.
There are a lot of people that it takes to make this happen, the care team, so whether that's an oncologist, surgical oncologist, the reproductive endocrinologist, the reproductive urologist, the oncology nurse navigators, the social workers, financial counselors, mental health support that these patients need. It's really a team effort. It's really nice when everybody has clear, open lines of communication, so we have to be able to reach each member of the team, too, because sometimes this is a time-sensitive process.
And I think something I've learned just in our team's work on this is how important advocacy is. So if laws aren't reaching patients, figuring out how we can make that more noticeable and where that's failing, too, which I think is a really important part of helping our patients and helping future patients is finding out what goes wrong in this process and how we make it better, too. Yeah, these are all really important points, and I think there are so many ways that we can tackle this and try to improve access to patients.
And I think Dr. Su mentioned this earlier, that it is so overwhelming to get a cancer diagnosis, and fertility oftentimes is not top of mind, let alone having to navigate all of these roadblocks. So I think it's so critical that we, as an organization, as providers, as health systems, do everything we can to really kind of lower the barriers to entry. Dr. Deebel, anything to add specific to kind of the sperm and the male side of things, as far as overcoming barriers, whether that's the male and crowd preservation or anything else that you think we've missed here? So a lot of great points have already been brought up by the rest of the people on this podcast, and I think that I have two more that I would bring up.
So one is on the male side, we see a lot of patients who are, you know, somewhere in the 40 to 60-year-old range, and they're diagnosed with various cancers that, you know, maybe the provider taking care of them or the field, so whether it be colorectal surgery or, you know, breast cancer, prostate cancer, even in our own space. Traditionally, people would not think of these patients as maybe being at the age that they want to be a father. However, these are gross, like, presumptions, and we see patients all the time who may come to us at the age of 50, for instance, with a colorectal cancer diagnosis, and, you know, nobody even asks them about fertility.
So I think what being a parent looks a lot different nowadays than what it did several decades ago, and so I think we should, you know, a key barrier is, you know, the general public assuming that because of the patient's age, maybe they don't want to have children moving forward. So I think this is really just a plug for, you know, what you mentioned, Dr. Halpern, that, you know, inquiring about fertility status with all patients being the standard of care is just really important. The other thing that I think, especially in the area that I practice, which is going to be, you know, the general Gulf Coast region, you know, I don't practice in a major mecca city, right? So I have patients coming from all over the Gulf Coast, and one of the things that has allowed for easier and faster access to care is telemedicine, right? So, you know, traditionally, patients, you know, we need to get them in urgently for an appointment, and they live three hours away.
Well, how are we going to do that? You know, nowadays, telemedicine has really allowed me to see patients from quite far away and get them plugged into the care they need much faster. So I think traditionally, transportation to doctor's appointments has been a huge barrier, and with some of the advancements in telemedicine, we're working to break down those barriers. Yeah, those are great points.
And I guess I would just add one more, which is what we're doing here today is breaking down those barriers by getting the word out, right? Making resources available for patients to understand, hey, here are the options. It's not just about producing an ejaculated sample. If you can't, there may be an alternative, and maybe that's not something that their local team is aware of or knows how to deliver.
But by getting the word out, helping patients understand that there's a lot of options, that this really should be front and center at a very turbulent and stressful time in their lives when they're getting this new cancer diagnosis. I think we're going to hopefully increase the number of folks who can get seen. This has been a really fantastic discussion.
I want to just conclude by going around the horn here and giving everybody an opportunity to really send a final message or thought. So I'll start, Dr. Deebel, with you. What's the one thing that you would all like to see a patient listening to this podcast take away? What's the one message that you want somebody to leave here remembering, understanding about oncofertility, fertility preservation, or any of the things we talked about? I think I would offer to patients that while it's certainly easier said than done, an initial cancer diagnosis is a very jarring experience and is a very, as you said, stressful time for patients.
But generally speaking, taking the time to think about life after cancer is very important. And with modern-day medicine advances, this is the reality for many patients. So I would just encourage patients to think about, you know, be positive and think about life after cancer and, you know, whether fertility is something they are still looking for.
Okay, Dr. Pekny, your final thoughts here. Yeah, I would just echo what Dr. Deebel said. I also think patients, don't be afraid to advocate for yourself.
Even if you're not sure what you want in the future, a consultation won't necessarily delay your care or mean that you have to make a final decision about what your childbearing or future fertility looks like. It just gives you information and options and a chance to make a decision doing whatever is right for you. Last but certainly not least, Dr. Su.
Well, Dr. Deebel and Dr. Pekny took all the good points, but another important point actually is practical. So there is more insurance coverage than ever. And so this could be more affordable than any cancer patient ever thought in the past.
And so it behooves you to ask your health insurer, I have cancer, do I have coverage for fertility preservation? And know that these are clinically recommended across all guidelines. And that's super powerful with insurers. So, you know, so painful to have to do that.
But man, if there's coverage that can make a world of difference in affordability. Such a great kind of practical point and tip to leave everyone with. I just want to thank everybody for your thoughts.
What a great discussion. I think we've covered a lot. There's a lot more that we didn't have time to cover.
I also want to thank all three of you for your outstanding clinical care in this space and your contributions to the academics and the research of oncofertility, because all three of you have really made fantastic contributions. With that, this concludes our episode of the SARP Fertility Experts Podcast. Thank you all for listening.
