A patient recently confided, “When my husband was diagnosed with cancer at 32, no one spoke to us about fertility.” That gap cost them a decade – and it was preventable.
Nationwide, only 44% of eligible patients have documented fertility counseling before chemotherapy; earlier snapshots at NCI centers were as low as 26%. Referrals often lag further at 4–30%. And despite >20 international guidance documents, implementation, not guidance, remains the gap.
Why do patients keep slipping through the cracks?
- System gaps: No default EHR prompts or order sets; unclear handoffs under treatment urgency.
- Clinician friction: Uncertainty about who “owns” the discussion; variable comfort; prognostic bias.
- Patient/structural barriers: Cost and insurance confusion; cultural or language mismatches; lack of navigation support.
- Communication gaps: Most counseling is verbal-only, rushed, or left to patients to initiate. Written materials and decision aids are rarely standardized.
The good news: fixes exist – and they work
Centers that redesigned their process consistently moved counseling rates from ~40% to >80%:
- EHR screen + auto-referral + virtual hub: A quick “reproductive potential?” screen triggers a BPA and one-click referral to a 48–72-hour REI tele-slot – improving goal-concordant care and time to consult.
- At Fox Chase, a new BPA drove a 450% increase in oncofertility referrals within six months
- Let’s TOC Fertility trial is formalizing this model across 20 clinics
- QI bundle: template + champion
At Johns Hopkins, a 20-minute staff in-service, a smart order set, and standardized consent note language lifted counseling from 37% → 81% in months - Oncofertility navigator with decision aids + age-appropriate resources
A part-time RN or coordinator who screens, refers, schedules, checks benefits, and closes the loop.- Navigator models consistently boost referral uptake and reduce barriers.
- With decision aids and age-specific resource, patients learn more, regret less, and act on FP referrals.
Sullivan et al. (2019) outline the core components of an effective oncofertility care model – worth reviewing if you’d like more detail.
What you can do in the next 30 days
- Flip your EHR default. Add a BPA trigger + one-click referral + documentation template.
- Name a champion and navigator. Even 0.2 FTE makes a measurable difference.
- Secure 48–72h REI tele-slots. Without rapid access, referrals stall.
- Standardize communication. Use a brief script + decision aid so every patient gets consistent, guideline-aligned information.
Start NOW: The American Cancer Society & Alliance for Fertility Preservation are running an ECHO program to help teams build these systems (free, online, ~1 hour/month, starts Sept 23).
✨✨Register here ✨✨
Fertility counseling doesn’t just prevent future regret – it gives patients hope, better quality of life, and real choices for what comes next.
When the next eligible patient sits before you – regardless of gender or race – take a moment to start the conversation about what’s possible. That single discussion can change a life.
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The Compass is your practical briefing on what’s working in oncology care – strategy, science, and systems. No fluff. Just implementation.
Suggested Reads:
1. Fertility preservation in people with cancer: ASCO guideline update