ASH Policy Statement on Coverage of Fertility Treatment in Hematologic Care

Fertility preservation and management is a critical aspect of reproductive health care to safeguard an individual's ability to have children in the future. The primary goal of fertility preservation is to provide options for reproductive life planning even after undergoing medical treatments or experiencing health conditions that pose a risk to one's reproductive capacity. Fertility preservation seeks to empower individuals to make informed choices about their reproductive futures while mitigating the potential impact of health challenges on their ability to conceive later in life. Fertility preservation is especially important to patients with hematologic conditions given the complexity of the conditions themselves as well as the regimens used in their treatment as they can have substantial detrimental impacts on the fertility of both male and female patients. Therefore, coverage of fertility treatments is an essential part of a complete health care action plan for patients with hematologic conditions.

Individuals with Hematologic Conditions

Several malignant and classical (non-malignant) hematologic conditions and related treatments can potentially cause infertility or impair fertility. Some examples of these conditions that may lead to fertility issues include:

• Aggressive forms of leukemia, especially when utilizing hematopoietic cell transplantation, high-dose chemotherapy, and/or total body irradiation, can have a significant adverse impact on fertility.
• Treatments for Hodgkin and Non-Hodgkin Lymphoma, such as gonadotoxic chemotherapy and abdominal or pelvic radiation therapy, can have a negative impact on fertility.
• Treatments for sickle cell disease, like hydroxyurea, may affect sperm production and egg quality, and chronic transfusions may lead to iron overload and impaired gonadal function.
• For hematopoietic transplantation or gene therapy for malignant or classical diseases, both treatments may cause fertility issues such as reduced sperm production, reduced or damaged eggs, and ovarian failure.

Coverage for Fertility Preservation

ASH is supportive of legislation and ongoing efforts aimed at providing comprehensive health insurance coverage for fertility preservation procedures for patients with hematologic conditions. Fertility preservation is a critical aspect of holistic healthcare for individuals with hematologic conditions, as it aligns with recommended medical guidelines and ensures that patients can safeguard their future reproductive options. ASH is committed to advocating for equitable access to fertility preservation services; fertility preservation promotes the overall well-being of hematology patients and empowers individuals to make informed choices about their health care.

Patients often encounter challenges when seeking health insurance coverage for fertility preservation before undergoing treatment (i.e., chemotherapy, gene therapy, hematopoietic cell transplantation) for hematologic conditions. ASH supports:

1. Public and commercial insurance providers offering affordable comprehensive coverage of fertility preservation services for hematologic patients. This is especially critical for patients who undergo a medically necessary procedure that may cause infertility.

• Even when patients have insurance, it may not cover the full range of fertility preservation options or the associated expenses, such as egg, sperm, embryo, testicular and ovarian tissue freezing, genetic counseling and testing, and related medical procedures and medications, and long-term storage.

2. Public health policies that create and foster health equity for patients, regardless of the state they reside in. ASH opposes legislation that threatens a person’s ability to preserve fertility prior to initiating treatment and supports legislation that protects access to these services, including in vitro fertilization.

• Federal and state laws and regulations can require insurance plans to cover fertility preservation. Existing state mandates are in a minority of states, their scope varies widely from one state to another, downstream implementation through insurance plans and clinics also varies widely, leading to disparities in fertility preservation coverage and access.

Finally, ASH encourages research funding aimed at fertility management and the connection between hematologic conditions and potential infertility. Advances in medical technology and treatment protocols are continually improving the prospects for fertility preservation among cancer survivors and individuals with hematologic conditions.

Conclusion

Fertility preservation is a crucial aspect of reproductive healthcare, especially for individuals with hematologic conditions where treatments may compromise fertility. These coverage challenges highlight the need for equitable comprehensive legislative and advocacy efforts to ensure that all hematology patients have access to fertility preservation services. Additionally, continued research funding for fertility management and the intersection with hematology can offer ongoing advancements and can improve patients' ability to make informed choices about their reproductive futures.