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.

    Couple questions:
    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.

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