If you’re reading this, I’m sure you’re thinking, “Oh great. Another person trying to scare me about fertility!” But hear me out as I hope by the end you’ll feel so empowered and excited about your fertility future, you’ll add it on your dating profile.
We’re currently near the end of this year’s National Infertility Awareness Week® (NIAW). This year’s theme is “Listen Up.” NIAW is an initiative started by RESOLVE: The National Infertility Association in 1989 to educate the public and raise awareness about fertility. At least one in eight couples have reproductive health and/or issues that can make building a family difficult.
However, when most people hear that statistic, it’s easy to brush it off. I know I did. Your first thought is either, “Well, that’s not me. My Catholic grade school teacher told me I could get pregnant super easily,” or, “I’m not interested in having kids now. I’ve got plenty of time!”
Here’s the thing: You may actually be totally fine but that doesn’t mean that you shouldn’t be listening up and thinking about your own fertility health, or medical history, right now.
Again, hear me out.
Anyone who has taken Accutane knows that if taken and a pregnancy occurs, it can cause serious birth defects. Through my work as a fertility advocate, I connected with a perfectly fertile woman who had survived a terrible car accident. She was going to have several surgeries that would put looking for Mr. Right (let alone trying to conceive) on hold, so she was looking into freezing her eggs. I also met a man who, when he was a child, was exposed to very specific farming chemicals. Even though he was single, he was concerned whether it would affect his sperm.
And that’s my point: While fertility may not be top of mind, you never know what medication, illness, accident, or unexpected event might impact it.
I was speaking to Dr. Serena Chen from IRMS about this and she also pointed out an example I hadn’t considered. “One situation that is becoming more common is bariatric surgery.” She said. “It’s better for these patients to lose weight and perhaps even be cured of their diabetes before having kids, but usually these patients are told to wait at least two years before conceiving. Age is one of the most common factors causing significant fertility issues in the US today.”
On the surface, I realize these scenarios may seem alarmist (not to mention a big ol’ bummer) but during NIAW, I really wanted to reach you, the fertile public at large, because NOT thinking about this might be something you genuinely regret later. And seriously, wouldn’t it make sense to be proactive about your fertility now as opposed to reactive?
“Having people understand their own reproductive systems is paramount here.” Lisa Rosenthal is a Patient Advocate & Editor in Chief with RMA of Connecticut. “Think of visually putting reproductive organs above all others- so that any time you need to be treated for anything, one the first questions should be, ‘How will it affect my ability to have a baby?’ That's what I would like to see; is that we protect our fertility potential FIERCELY. That we think of it before everything else so that when we get a diagnosis, it's our next thought.”
Of course the big illness that immediately comes to mind that can directly affect your fertility is cancer. Especially a diagnosis of either testicular cancer or ovarian cancer as it impacts your reproductive organs. The treatment alone can potentially damage the organs necessary to reproduce. For example, women may not be able to produce eggs if radiation to the pelvic area be necessary. You also may need to have reproductive organs removed altogether, such as the removal of both testes which would prevent a man from producing sperm.
This is why it’s so important if you’re given a cancer diagnosis (or really, any illness you worry might impact your having children) to think ahead and ask important questions. I asked Dr. Peter Klatsky from Spring Fertility on what advice he’d recommend to a patient regarding protecting their fertility, and he advised, “Understanding their status is the first step. For a woman in particular, an AMH (Anti-Mullerian Hormone) and antral follicle count are helpful tools.”
Whether you’re male or female, the three questions that should always be included on your list of concerns are:
1. Could either this treatment or my illness affect my ability to have children or my fertility?
2. Is it safe for me to delay my treatment to preserve my fertility?
3. What happens if I become pregnant during treatment?
Dr. Chen also points out, “Even if there is zero direct harm from cancer treatments, there is the issue of time. We know the passage of time has a significant, negative impact upon female fertility in particular. Some oncologists will recommend waiting at least two to five years without any kind of disease before giving the patient the all clear to conceive. So if you are diagnosed at 30, and cannot conceive until you are 35 – you are automatically significantly less fertile due to your age alone, much less any impact from your cancer or your cancer treatment.”
Time and age overall, especially for women as it relates to egg quality, is always something to consider. Father Time is particularly heartless when it comes to women and fertility.
Another factor to take into account is that fertility preservation, whether its egg, sperm, or embryo freezing, is often not covered by insurance.
As Dr. Chen states, "There are a lot of other medical issues that can impact fertility – why should only cancer patients be covered? Insurance companies are using current guidelines as an excuse to deny fertility preservation to many patients that should have fertility preservation – because “she does not have cancer.”
When I asked Dr. Klatsky why he thinks insurance doesn’t cover preservation in these cases, he answered, “Lack of understanding about the benefit, perceived cost, and, in general, women’s health is especially underserved. Historically, women had to pay co-pays for birth control pills. It seems that it takes longer for insurance to adequately cover effective reproductive health services.”
“Insurance companies, often incorrectly, think it's too expensive to cover fertility preservation methods. In fact, not preserving eggs/sperm/embryos can cost the insurance companies far more,” states Rosenthal. “Also, if a person does not have fertility preservation covered, they may consider more radical surgical options so as to avoid medication/chemotherapy options. And the surgical costs would be more than fertility preservation methods.”
Dr. Chen adds, “I believe that insurance companies tend to say no to everything until they are forced to say yes, in order to try and save money up front, but as a society we need to take the long view and see the big picture in order to survive and thrive.”
Again, no one wants to think about any of this. I certainly didn’t want to when I was diagnosed with “unexplained infertility.” So think of me, if you will, as either a helpful, infertile, big sister or as the “Ghost of Infertility Future.” I’m lovingly haunting your doorstep as I’d like to spare you from the added cost, emotional drama, and the potential worry should you take an interest in your fertility health this second.
This is why for now, it’s so important for you to be your own advocate. Think of it as investment in the family you hope to have. You have insurance to protect your home and your car; why wouldn’t you look into something that could help protect your fertility?
Being proactive starts with you asking questions about your medical record. Not only of your doctor but even of those who raised you. You might have something in your medical history past that might help you get access to fertility treatment in the future.
And if you can’t afford fertility preservation or even a simple fertility work up (just as a check to see what your current status is), this is another opportunity to advocate on your behalf. According to a survey by Mercer Health and Benefits and commissioned by RESOLVE, 65 percent of employers offering fertility treatment cited they were responding to employee requests for covering fertility benefits. You should feel empowered to speak to your human resources department about adding the benefit.
So in the spirit of NIAW, I truly hope that even if you are a fertile myrtle, you’ll listen up to my message and start thinking about this now. The future parent in you will thank you.