Huang Emily Y, Shandley Lisa M, Mehta Akanksha, Kobashi Kathleen C, Muthigi Akhil
Department of Urology, Houston Methodist Hospital, Houston, Texas.
Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia.
Urol Pract. 2025 Mar;12(2):194-201. doi: 10.1097/UPJ.0000000000000735. Epub 2024 Oct 11.
Iatrogenic infertility can result from medically necessary treatments that reduce fertility potential such as gonadotoxic chemotherapy and radiation but also brain and pelvic surgery, biologics for autoimmune disease, and hormone therapy. Fertility preservation (FP) involves freezing embryos, oocytes, ovarian tissue, sperm, or testicular tissue for future procreation and may be the only option for some patients who hope to use their autologous gametes for future reproduction. Although there is a growing awareness to refer patients at risk for iatrogenic infertility to reproductive specialists, patients seeking FP continue to face a multitude of barriers. The most prohibitive factor is cost, but poor accessibility to specialty care, lack of education of providers and patients, and stigmatization around reproductive health may all lead to delayed referrals. We discuss several opportunities for the reproductive medicine workforce to help address barriers to FP. One method to make FP more accessible to patients in a shorter time frame would be to make it more affordable through improved insurance coverage. Currently, there is no active federal legislation mandating that insurance plans cover FP; however, there have been several success stories at the state level. In addition, education of providers and patients through multispecialty collaboration and targeted campaigns can have a profound impact on expediting referral for fertility care. Promising new technologies and innovation in health care delivery are also on the horizon. Unaddressed fertility concerns are very distressing to patients and detrimental to their quality of life. Urologists can contribute significantly to improving the care for these patients clinically and through advocacy and education.
医源性不孕症可能源于降低生育潜力的必要医学治疗，如性腺毒性化疗和放疗，也可能源于脑部和盆腔手术、用于自身免疫性疾病的生物制剂以及激素治疗。生育力保存（FP）包括冷冻胚胎、卵母细胞、卵巢组织、精子或睾丸组织以备未来生育，对于一些希望使用自身配子进行未来生育的患者来说，这可能是唯一的选择。尽管越来越多的人意识到应将有医源性不孕症风险的患者转诊给生殖专家，但寻求生育力保存的患者仍然面临众多障碍。最具阻碍性的因素是费用，但专科护理难以获得、医护人员和患者缺乏教育以及生殖健康方面的污名化都可能导致转诊延迟。我们讨论了生殖医学工作者帮助消除生育力保存障碍的几个机会。在更短时间内让患者更容易获得生育力保存的一种方法是通过改善保险覆盖范围使其更经济实惠。目前，没有联邦现行立法强制保险计划涵盖生育力保存；然而，在州一级已有几个成功案例。此外，通过多专业协作和有针对性的宣传活动对医护人员和患者进行教育，可能会对加快生育护理转诊产生深远影响。有前景的新技术和医疗保健服务创新也即将出现。未解决的生育问题对患者来说非常痛苦，且对他们的生活质量有害。泌尿科医生可以在临床以及通过宣传和教育为改善这些患者的护理做出重大贡献。
