Fertility Preservation Counseling for Stem Cell Transplant Patients

Children and teens who undergo treatment for cancer can experience lasting effects, including risks to their future fertility and reproductive health. Now, providers at Children’s Hospital Colorado are working to standardize how and when patients receive fertility counseling prior to cancer treatment, in hopes of further exploring what future quality of life might mean for survivors of pediatric cancer.

Fertility after a stem cell transplant

Pediatric patients who receive a stem cell transplant aren’t always aware that the therapies included in their treatment could affect their future ability to conceive. To help patients and families better understand their risks and options before undergoing treatment, Rohini Chakravarthy, MD, MPH, used her time as a stem cell transplant and cellular therapy fellow at the University of Colorado School of Medicine to increase the number of patients being referred to the Fertility Preservation and Reproductive Late Effects (FPRLE) Program.

Dr. Chakravarthy developed and implemented this project under the guidance of Children’s Colorado gynecologist, Leslie Appiah, MD, and pediatric stem cell transplanter Vanessa Fabrizio, MD, MS.

“I really wanted to start with making sure that we are standardizing conversations and making sure that all patients are receiving the appropriate counseling, so they can make the decision that is right for them,” Dr. Chakravarthy explains.

Fertility preservation counseling

Creating more consistent patient-family conversations involved implementing changes to the Epic system, such as embedding a referral to the FPRLE team for every patient that has a bone marrow transplant consultation and creating a fertility-preservation checklist for coordinators assisting patients before a transplant.

Ten months after these changes went live in Epic, the number of patient referrals to the FPRLE team increased from 34% to 81%. However, the number of patients pursuing fertility preservation stayed the same. This opens more doors for exploration: What are the barriers and concerns preventing patients from opting into fertility preservation? What do patients need to know about fertility after a stem cell transplant? How might providers anticipate and mitigate challenges to ensure all patients have more options for starting a family if they choose?

“When talking to a family about a new diagnosis and all of the therapies they’re going to go through, it’s very difficult for them to think past a short-term cure,” Dr. Chakravarthy says. “It’s up to us as providers to give patients and families all the information not only regarding the immediate effects of their therapy, but the long-term effects, too.”