As I See It: The double whammy of cancer and infertility

This is an account of one vulnerable patient versus a powerful health insurer. She is a married woman of child-bearing age whose lifelong dream to be a mother got crushed.

I met Megan (name changed) when I was working as a certified women's health nurse practitioner in a large reproductive health center in Boston. Prior to arriving at my office, this 25-year-old woman had just been diagnosed with lymphoma. Her oncologist recommended a chemotherapy regimen that was associated with a high cure rate. However, the same treatment that would save her life would ultimately cause her to become infertile.

Megan scheduled an appointment with me to discuss options for fertility preservation before confronting the toxic effects of chemo. I informed Megan that there was an available treatment within her reach. She could preserve her fertility by undergoing a procedure called In Vitro Fertilization or IVF. This procedure involves combining egg and sperm cells in the laboratory. Once the eggs are fertilized, the embryos are transferred into the women's uterus. If implantation is successful, a pregnancy is created.

What was out of reach for Megan were the financial resources needed to pay for IVF. Her corporate insurer denied the prior authorization request for payment of this important treatment. Megan's only option was to pay the $12,000 out-of-pocket cost for the one procedure that would help her conceive a biological child. Upon hearing the rejection from insurance and with no means to secure a loan, I witnessed Megan as she was overcome by emotional pain, perhaps worse than what she experienced with her cancer diagnosis. My heart broke, and I bet yours would have, too.

Megan had pledged to fight her battle against cancer with faith and courage. But she considered a future without a child to be no future at all.

Megan's large commercial health insurer, like others, will tell you that there are too many people like Megan who seek fertility preservation treatments. They'll also tell you that reproductive health services along with cancer treatments will drive up costs.

They are wrong:

• According to the National Cancer Institute, only about 5 percent of new cancer diagnoses in the U.S are among people ages 15 to 39.

• A 2017 report prepared for the Maryland Health Care Commission estimated that reproductive health services would increase insurance costs only 24 cents more per month.

• It has been reported that coverage might lead to lower rates of depression and lower support costs for infertile patients--actually reducing health care costs.

Megan is not alone in being forced to abandon her dream of being a mom:

• As many as 2 in 3 people who undergo cancer treatment will be rendered infertile by chemotherapy or radiation.

• The majority of women who elect not to undergo fertility preservation cited costs and lack of insurance coverage as the reasons.

Finally, lawmakers on Capitol Hill are responding with leadership. The Access to Infertility Treatment and Care Act (HR 2803 and S 1461) before the U.S. Congress will require private and federal health plans to provide coverage for all women and men undergoing infertility treatment without raising insurance or copayment fees. This includes coverage for individuals undergoing medically necessary procedures that may cause infertility, such as chemotherapy.

The Access to Infertility Treatment and Care Act is not just about helping Megan and others realize their dreams of being a Mom. The act also addresses inequity in health care. The Georgetown Journal on Poverty Law and Policy describes the financial barriers to infertility treatment as discriminatory and oppressive, since these obstacles disproportionately affect low-income women of diverse race, ethnic backgrounds, and lower socioeconomic status.

I will continue to confront heart-wrenching cases like Megan's experience unless our lawmakers hear from you and act on the legislation before them. Please tell your Senators and Representatives to adopt the Access to Infertility Treatment and Care Act. Tell them we simply don't know whose daughter, sister, and extended family will be felled next. You can find their names and contact information at https://www.govtrack.us/congress/members/MA

Big health insurers will not provide the public with the basic right to a family until Congress requires them to close the unfair gap in reproductive health care. Cancer survivors deserve a little bundle of joy, not a second heap of heartache. Please contact your members of Congress today.

- Jennie Mastroianni is a certified women's health nurse practitioner working in the Boston area.

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