Sarah H. O’Brien, MD, MSc
The American Society of Hematology’s (ASH) Working Group on Maternal Health in Hematology will hold its second maternal health session at the 65th ASH Annual Meeting and Exposition. While last year’s session focused on different aspects of reproductive health rights, this year’s session, titled “Maternal Health: Fertility Preservation in Hematology Care,” will examine fertility preservation through three different lenses: the nuts and bolts, the patient, and the physician.
Sarah H. O’Brien, MD, MSc, pediatric hematologist/oncologist at Nationwide Children’s Hospital in Columbus, Ohio, chairs the session and emphasized that “ASH is committed to the right of maternal health care.” Moreover, she noted that as hematologists become increasingly aware of maternal health, they recognize the importance of weaving it into all aspects of health care. As for the information to be covered in the session, she explained it is tailored to anyone who can get pregnant or who cares for someone who can get pregnant.
The session will include three speakers. Erica Marsh, MD, MSCI, a professor of obstetrics and gynecology at the University of Michigan Medical School in Ann Arbor, will address “Fertility Health Equity and the Fertility Preservation Process”; Alison Loren, MD, MSCE, chief of the Division of Hematology-Oncology at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, will present on “Fertility Care for Patients with Hematologic Conditions”; and Mindy Christianson, MD, MBA, chief of reproductive endocrinology and infertility at Cleveland Clinic in Ohio, will speak on “Fertility Care for Physicians.”
Fertility Health Care
Dr. Marsh and Dr. Christianson are nationally recognized gynecologists, and Dr. O’Brien noted that their voices in the program serve as an example of ASH’s important initiative to incorporate more gynecologists into the Society’s work. Dr. Marsh’s presentation will describe the nuts and bolts of fertility preservation and detail who does and does not have access to the fertility preservation process.
“I hope the audience will come away from the talk with a better understanding of inequities in fertility health care,” Dr. O’Brien said.
She explained that because state laws can affect both the collection and storage of embryos, physicians may become nervous about providing this form of health care as these laws change, especially because many of them appear to be written with the intention of creating confusion. “These bills are typically not written by medical providers,” Dr. O’Brien said, adding that “confusion creates hesitancy.”
At last year’s annual meeting, there was an education session focused primarily on fertility preservation in sickle cell disease.1 Because of this, explained Dr. O’Brien, this year’s talk will concentrate on hematologic malignancies. Dr. Loren, an expert in fertility preservation, is also senior author of the American Society of Clinical Oncology (ASCO) Clinical Practice Guideline Update titled “Fertility Preservation in Patients with Cancer.”2 The update was based on the identification and review of 61 publications but did not prompt significant change to the 2013 recommendations and states, “All oncologic health care providers should be prepared to discuss infertility as a potential risk of therapy.”
The guidelines also recommend encouraging patients to participate in registries and clinical studies to help further define the safety and efficacy of interventions and strategies such as embryo cryopreservation and cryopreservation of unfertilized oocytes. The guidelines emphasize that ASCO considers cancer clinical trials vital to informing medical decisions and improving cancer care, and, therefore, all patients should be given an opportunity to participate in them.
Additionally, the guidelines state that health care providers should refer patients who express an interest in fertility, as well as those who are ambivalent or uncertain, to a reproductive specialist as soon as possible. Moreover, any patients who are distressed about potential infertility should be referred to psychosocial providers. Lastly, in the case of post-pubertal children, the guidelines recommend that providers suggest semen or oocyte preservation (with parent or guardian consent).
Dr. O’Brien noted that one in four female physicians will experience infertility, a number that compares unfavorably to the U.S. Centers for Disease Control and Prevention statistic of one in five for the overall female population. The high rate of infertility has become an increasingly important topic for hematology trainees, and this presentation is meant to help them manage their own health.
“Women in hematology tend to wait longer to have a family,” Dr. O’Brien said, and this delay in combination with the stress of a job in hematology can affect fertility. “I hope as physicians we come away with a better understanding of how infertility is affecting our field,” she said. “More and more women are in medicine … so this issue is just going to keep increasing in importance over time. What is really special about the session is that we are including how [the topic] affects physicians.”
- Pecker LH, Nero A, and Christianson M. No crystal stair: supporting fertility care and the pursuit of pregnancy in women with sickle cell disease. Hematology Am Soc Hematol Educ Program. 2022;2022(1):459-466.
- Oktay K, Harvey BE, Partridge AH, et al. Fertility preservation in patients with cancer: ASCO Clinical Practice Guideline update. 2018. J Clin Oncol. 2018;36(19):1994-2001.
- American Society of Hematology. Maternal Health Care Resources. Accessed Sept. 15, 2023. https://www.hematology.org/diversity-equity-and-inclusion/maternal-health-care-resources.
Maternal Health: Fertility Preservation in Hematology Care
Sunday, December 10, 9:30 a.m. - 11:00 a.m., San Diego Convention Center, Ballroom 20AB, Upper Level