There is something oddly poetic about fertility and cancer. 

One day, you learn you have cancer. And then, right at that moment when you are about to start the fight of your own life, you are asked if you want to preserve the ability to create another life. 

That conversation happened for me a few hours after my cancer diagnosis. It put my wife and I in hyperdrive, trying to figure out where the closest sperm bank was located and how to get my sample there given that I couldn’t leave the hospital.

Today, doctors and social workers are better at this planning conversation. But they aren’t perfect. 

Research from Andreana N. Holowatyj, an assistant professor of medicine and cancer biology at Vanderbilt University Medical Center, shows that about half of young cancer patients aren’t given the fertility talk before treatment. 

“One of the challenges I’ve seen is doctors saying: ‘I don’t know what to provide them.’ So, if a patient says yes, they are interested, there’s a sense of what now?” says Dr. Holowatyj.

If your doctor doesn’t bring up the ins and outs of fertility planning, you need to ask these questions and ask them right away. Among the questions to ask, according to Memorial Sloan Kettering: 

– Have other survivors been able to get pregnant naturally after receiving the same treatment that I received?

– If I’m at risk for infertility, but I’m not ready to have children yet, can I freeze eggs, embryos or sperm now to preserve my fertility for the future?

– If I carry a pregnancy, are there any risks to me or my baby based on the treatment I received?

In the past six months, I’ve met with fertility doctors, survivors, ethicists and non-profit executives, all examining these and millions of other questions around cancer and fertility. And while they can all help and offer guidelines, tips and tricks, only two things are clear: You are your own best advocate, so ask as many questions as you need. And this is your personal decision, not theirs. 

As complicated as the process can be before treatment, it can be just as hard after. Nearly every survivor I spoke with examining fertility faced some kind of hurdle along the way. 

For many, the hurdle is financial. FertilityIQ says that the total costs for in vitro fertilization reach into the range of $40,000 to $60,000. In vitro fertilization is a common process for survivors. Surrogacy, another option, can cost $100,000 to $200,000, according to doctors at Memorial Sloan Kettering and elsewhere. 

To battle against those costs, you need to be strategic about your health insurance and maximize any company benefits. You can also look to work with several large organizations trying to help. Among them are RESOLVE: The National Infertility Association, which has dedicated resources for cancer survivors, and Livestrong, which helps shoulder the cost of fertility preservation and treatments. It even partners with select clinics to offer significant discounts. 

Many smaller, community focused groups all over the country are also in place to help. One of the fastest growing ones is run by Michael and Megan Scherer in Columbus, Ohio.

Michael and Megan are high school sweethearts. They got married at 23 and planned to spend those first few married years focused on their careers. Megan as a marketing professional, and Michael as a registered investment advisor. 

But at 26, Michael was diagnosed with testicular cancer. 

Before his surgery, in 2011, Michael wasn’t really planning on sperm banking. Megan made him pause and do it. In June 2012, a year out from his surgery, Michael found out the cancer had spread. He sperm banked again and went through three rounds of chemotherapy. 

By 2014, Michael had recovered and the Scherers were ready to think about having a family. When they did, they encountered surprises at nearly every turn. 

Their oncologist team didn’t really help–as curing cancer was their specialty, not life after. And when they went to a fertility specialist, the doctors diagnosed them with “unexplained infertility.” 

“They treated us like any other couple that had had problems. Not as a cancer survivor,” says Michael.

They initially started intrauterine insemination, or IUI, and went through one, then two, and eventually six rounds. It cost them well over $20,000 in the end and they had used nearly everything Michael had put in the sperm bank. 

“They never even warned us that this could be the last ever when we got to the last round. They just said we’ll add it all in,” says Michael. 

On the seventh, and absolutely final IUI, it worked. It worked in part because they used several more fertility drugs in addition to the IUI. Several fertility doctors have since told them that they should have been doing this from the start. 

“In the benefit of hindsight, we realized how bad it all was,” says Michael.  

When Covid happened, they had the time to think about the experience. It inspired them to stop thinking and start acting. 

At first, they used their savings to help one couple a year. Their first grant was for a testicular cancer patient in Ohio. Eventually, they started getting money from friends and family who could donate and people started hearing about them on social media. 

Today, they run something much bigger called “Worth the Wait.” 

The nonprofit offers fertility counseling. It has an education program. And new this year, they are training patients who received grants to start educating others. 

“With cancer, I had the steps. I was told we are going to do this, and here’s why. With fertility, it was more: We are going to try and keep up hope. There were no steps and plan,” says Michael. 

Fertility is merely one of many places where money plays an outsized role in determining whether you get the care you need. Money comes up everywhere with cancer, sadly.

Some amazing researchers are in overdrive trying to examine the exact connection between your finances and your health in treatment and recovery. This field of study is called “financial toxicity” and I’m constantly surprised by one finding or another.

A recent study from the University of Chicago, in particular, caught my eye and is worth a read. In it, the researchers found higher levels of financial toxicity lead to lower quality of life and more phsycological distress. It’s also a type of stress that lingers for years and years.

Emboldened by the findings, the researchers then argue for better toxicity screening at hospitals and more dedicated financial navigators for patients. They also want physicians to give more up-front information about treatment costs.