ideasIdea
Fertility preservation offered and funded by default before gonadotoxic treatment
Everyone of reproductive age about to have treatment that can cause infertility is offered egg, sperm or tissue freezing, paid for, before treatment starts.
Guidelines recommend fertility counselling for all patients of reproductive age, but referral rates remain low and cost is a common barrier. The proposal is an opt-out pathway: automatic referral triggered by age and regimen in the prescribing system, guaranteed appointments within a week, and funding from the payer for preservation and storage. Outcomes include referral rate, preservation uptake and treatment delay.
Hypothesis
Opt-out referral raises documented fertility counselling above 90% and preservation uptake severalfold without delaying treatment start by more than a few days.
Rationale
Infertility is among the most regretted long-term effects and the intervention window is short; default pathways fix omission better than education.
What would test it
Stepped implementation across a network; primary endpoint documented counselling and preservation rates, secondary treatment delay and long-term regret.
Maturity
being tested at scale
Who has to act
payer
Cost to try
Medium ($1M to $50M)
Years to first evidence
2
Bottlenecks it attacks
- Toxicity and quality of life are undervalued · Trials measure how long people live, not how they live. Side-effects are under-reported and under-treated.
- Survivorship and late effects are neglected · Tens of millions of people live after cancer with heart damage, infertility, second cancers and fear, and few services.