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Given the unknowns with regard to fertility issues and ICIs and targeted therapies; we have been counseling patients about the possibility of sperm/egg harvesting. I have to be honest and say this is a little unsettling to tell patients we “just don’t know”. Sperm banking, technically is relatively low tech; however, egg retrieval is a bigger deal (admittedly I know next to nothing about it). The ramifications of this recommendation, I imagine, could be significant (emotionally, physically) not to mention the costs! As alluded to above, this tends to pertain to the adjuvant setting primarily. In the metastatic setting; that conversation is entirely different.
1) Does anyone know if insurance will cover costs for fertility (male or female) counseling for patients in the adjuvant setting. Since this is not “antineoplastic chemotherapy” I would fear it would not be covered at all.
#2) Does anyone know of a fertility specialist at their institution (or anywhere else) that may be willing to act as a resource? It would be great to have some experts weight in on this.
#3) What is the responsibility of Pharma in these situations? Can they release data about any post-Rx pregnancy complications or infertility issues s/p Rx on ICI or targeted therapy (post marketing data I would suspect) or data from expanded access trials.
I would appreciate any insight anyone has to offer. These situations are challenging; and I feel like a fish out of water.