Marrow Masters

Preserving Fertility Through Cancer Treatment

Episode Notes

This is a special episode of the Marrow Masters Podcast.  Not only do we have two guests, but we are also diving into a very important topic that isn't often discussed.   When you're facing transplant, fertility may be the furthest thing from your mind.   But chemotherapy, radiation, and other treatments could impact your body's ability to start a family.  That's why it's critically important to at least have a conversation before starting treatment.

Today's guests are Dr. Quinton Katler, a reproductive endocrinologist at Shady Grove Fertility, and Emily Beard, a Registered Nurse with Northside Cancer Institute.  They are here to share their perspectives and talk about options.

Fertility preservation can take as little as two weeks.  And while some patients must begin treatment immediately, there are many cases in which a two-week delay will not impact a patient's prognosis.   A patient in their 20's, for example, may not be thinking about starting a family right now, but could have plans to later in life.  This is why it can be critical to look at options, and have a collaborative conversation with his or her entire team.

Emily talks about the mental health issues surrounding these conversations, and Dr. Katler gets into the medical options.  These can include egg harvesting and freezing, embryo freezing, and freezing of sperm.   These are ways to preserve the building blocks of life before they can be damaged by cancer treatment.   Following treatment and a waiting period, Dr. Katler walks us through the processes of IUI, IVF, and more.   And of course there are other options, such as adoption.

Many of these procedures do come with "sticker shock," and we have a comprehensive list of resources available to our listeners, including:

American Cancer Society:

Live Strong Family Building Options including Fertility Preservation:

Fertility Scout (from Alliance for Fertility Preservation):

Oncofertility financial assistance

Team Maggie’s Dream (need based grants available for fertility preservation costs):

The Sam Fund:

Other small non profit organizations that support family building in various ways

Worth the Wait (funding for family building options e.g. IVF, adoption, surrogacy, et.) -

Verna’s Purse (funds for storage fees through Reprotech) -

LiveStrong financial assistance –

Northside Hospital Cancer Institute:

Shady Grove Fertility:

Newsletter about this topic:

National Bone Marrow Transplant Link - (800) LINK-BMT, or (800) 546-5268.

nbmtLINK Website:

nbmtLINK Facebook Page:

nbmtLINK YouTube Page can be found by clicking here.

Thank you to this season's sponsors:

The Leukemia & Lymphoma Society,



Episode Transcription

Peggy: Welcome everyone. Today is going to be special. We have two people that we're gonna talk to. Two very special people. I'd like to welcome Emily Beard, a registered nurse with the Northside Cancer Institute and Dr. Quinton Katler, a reproductive endocrinologist at Shady Grove Fertility in Atlanta, Georgia.

Together today, they're going to tackle fertility preservation and provide an abundance of information and resources. This is going to be really great for so many people starting their journey at a young age, to know what their options are. So let's get started. What does it mean to preserve fertility for both a male and a female?

Quinn: I can tackle that question first. Peggy. First things first. Thank you so much for having me. The question about fertility preservation. So the reality is regardless of the reason for chemotherapy and or radiation and bone marrow transplant, whether it's a cancer diagnosis, an autoimmune disease, or a medical diagnosis, the impact of chemotherapy and radiation on fertility is extremely unfair, and from my experience, tends to be a significant slap in the face for patients, and that's the main reason why I'm so passionate about talking about this.

So patients are given a grave diagnosis and they have to go through very difficult treatment, and they're oftentimes told that the treatment may prevent them or have a negative impact on their ability to have kids in the future. And really the last thing that patients want to be thinking about is how this treatment may negatively impact their ability to build a family in the future.

But why I'm here today is to really hone in this notion that it's important to know that there are options for preserving fertility, most of which can be done in a relatively quick manner before chemotherapy or radiation treatment. So taking a step back from a big picture standpoint, the main options of fertility preservation. Freezing sperm for men before treatment, as well as egg freezing or embryo freezing for women. 

Peggy: Okay, well, this is a great start. So let's talk about the procedures and how long does it take to complete them? 

Quinn: Peggy, timing is a really critical piece to this whole conversation, and it's really important that this discussion of fertility preservation commences before any treatment actually starts.

As we know, things tend to move really quickly, especially when timing chemotherapy treatment, so the sooner that a patient can speak with a fertility specialist, the better. The first thing, and probably most important is we should never assume that patients want biological children. However, if this is something that our patients are ambivalent about or they haven't really thought about and they wanna keep that option open, It may be prudent to have them speak to a fertility specialist about the process of preserving fertility and what that timeline actually looks like.

Just speaking from my own experience, I know when I was a teenager, I definitely was not thinking about how many children I was going to have or what my personal family size would look like, and most people that are in this situation haven't thought about that. But if there's any iota of consideration for building a family, this conversation with a fertility specialist is super important.

The other piece to this puzzle is that having this conversation with a fertility specialist is non-committal, meaning you can do just that. Have a conversation with a reproductive endocrinologist or a fertility doctor. And sometimes just having that conversation about fertility and the impact of this treatment may have on their family building goals can be helpful in and of itself without actually proceeding with treatment.

However, it's critical that the primary medical team refers patients who are expressing any interest in fertility preservation or any interest in building a family at some point in their lives to a reproductive specialist or an REI physician like myself, it's always a priority for the medical team to balance this time period.

There's always a consideration about starting treatment immediately, kind of balanced against this desire to undergo fertility preservation. So the timing really is probably the most important piece as we'll talk about. There are newer approaches to fertility preservation that do not require as much time. So, for instance, with egg freezing or embryo freezing, the entire process from start to finish can take about two weeks. . 

Emily: And I would say that this is where having a coordinated conversation, and hopefully having providers, oncologists, as well as nurses, bringing up the issue as early as possible so that patients can get in and get the information that they need quickly.

And there are certainly circumstances where a patient's diagnosis and the urgency of their treatment might make it seem less ideal to stop and have that conversation or even to stop and go through the process of preserving the patient's fertility. But I think it is really important to at least pause and have the conversation and acknowledge that the possibility of family building is there and have that be part of the shared decision making between the patient and the provider.

Every person's circumstance is different, and we certainly recognize that there are multiple scenarios in which a patient's life and the importance of starting treatment immediately would negate the opportunity to go through the procedures that we've talked about. But I think it's really important from a patient advocacy standpoint to just give that patient the benefit of the conversation and the information, even if it's just to acknowledge that the clock is ticking and that the recommendation is to proceed with treatment. Just to acknowledge that loss that they might be feeling or will, would feel in the future. 

Peggy: Oh, Emily, thank you. And you too, Dr. Quinn. So I'm thinking about across the nation, there's different centers. Some centers are probably gonna be more on the ball about this. So this is why this is so important for someone to realize on their own that if they're not being asked about this, they have to advocate for themselves, which takes us to available resources. So how does one navigate this, if perhaps their center is not being upfront about, we have to consider this. 

Emily: I can take this one. This is an area as a nurse, as an oncology nurse and someone who has worked as an oncology navigator. I've been in this situation multiple times where everyone's kind of looking at each other, saying, who, whose responsibility is this to discuss this with the patient?

And as you said, Peggy, like in many different circumstances, it could be that the patient is having this conversation with their oncologist at their first visit if they're in the office, if it's a clinic. It could be that they've been admitted to the hospital and the hospitalist or someone from the hospital's medical team is seeing the patient.

In which case really in either scenario, it could be that the social worker, a nurse, some sort of care coordinator or even a psychologist or someone from behavioral health might be the one to bring this up. Fertility preservation is considered a survivorship issue and a lifestyle concern, and so it's certainly a priority for the cancer team. But again, it may not be coming up if someone is very, very sick. And so that's where I would encourage the patient or the patient's family member or caregiver to ask the question. You know, if there's some discussion of initiating treatment to say, Hey,I've read that impact on fertility could be a long-term effect of cancer treatment.

Can you tell me a little bit more about that and what my options are? So getting that conversation started, if it's not started by someone on the team. Really, it can mean a lot to the patient. And as Dr. Katler mentioned, most of these patients have not had this conversation before.

They're in their teens and their twenties. They probably haven't had the reason to stop and think about their fertility and their plans for the future. So oftentimes this is coming out of left field. And if it's someone who's a little bit older and who might have thought about family building, but maybe hasn't met the partner that they wanna build their family with, or aren't quite at the point in their life or their career, this conversation just maybe hasn't come up and they don't know what their options are.

So I think we have to assume nothing and be prepared for what questions patients may have. And not assume that someone is either too young or too old, or already has children or doesn't have a partner or whatever story we may tell ourselves as providers about why a patient may not wanna have this conversation.

Peggy: Absolutely. Oh, I'm so glad we're talking about this. Now Emily, I know you have so many resources up your sleeve and we can absolutely include those in the show notes, but are there a few you'd like to touch on during the podcast? 

Emily: Yeah,, I think the first place a lot of people go is the American Cancer Society.

Certainly just the general cancer information organizations have great resources on this. So if you wanna just have some basic information on fertility preservation and the information available to people with cancer, those resources are great places to. LiveStrong also has resources both for information about options, but also some financial assistance available, as well as the Alliance for Fertility Preservation has a really nice website and provides a PDF that goes into male and female reproduction concerns around cancer treatment.

So that's something that's really helpful both for patients and providers. Just some talking points. And then there's a great website called Save My Fertility that provides these pocket guides. So again, for providers, if you're interested in having these available to your patients or even for patients to go onto their website, you can just download a very sort of quick guide that talks through this.

Financial assistance is usually the big barrier for folks. So financial assistance resources are something I always like to bring up. I'm very proud and Dr. Katler is actually a part of this group as well, but I'm very proud to be part of Team Maggie's Dream, which is a nonprofit organization located in Atlanta.

We do provide grants for cancer patients throughout the country. So it's not just an Atlanta resource, it's really for everyone. We've helped people in, I think just about every one of the 50 states. We've helped about 270 young people with cancer over the last six years, and we provide small grants.

So they're grants that help to defray the cost of fertility preservation. We can put the website in the show notes, but Maggie's a real person. She was a breast cancer patient in her early twenties who was devastated when she determined that her fertility might be impacted by her treatment. And so her family helped her put some finances together to go through the fertility preservation process, and she was able to start her treatment with some eggs banked, and then they decided to pay it forward as a family.

When their treatment was completed, they began this nonprofit. And so Dr. Katler's on our medical board and I'm currently on the board and the chairman. And so we're really happy to be able to provide some support for patients. As well as just a network of other patients who've gone through this and just really a network of survivorship and hope for families that are facing this difficult time.

So I also wanted to mention the SAM Fund, which is an organization that helps to provide grants as well for cancer patients. And then there are a couple of others as well that we'll put in the show notes. I did wanna mention Worth the Wait, which is another organization that helps with some of the costs later.

So for things like adoption, IVF, donor egg costs, things like that. And then there is Verna's Purse, which helps patients pay for storage fees. And that's through ReproTech. So again, these will be in the show notes, but I mostly just want people to know that there are resources that financial um, the cost of going through fertility preservation is overwhelming and should not be a deterrent for folks that really feel like this is something that they want to do prior to being treated.

Peggy: Oh, Emily, I couldn't agree more and awesome that both of you are on the board and there's so many resources here. We will surely include them, and I thank you for all of this. So I'll ask Dr. Quinn this. What can someone do if they've completed their treatment, their post-transplant, and now they're wondering what their fertility status is?

Quinn: Sure. So first things first, once the person or the couple has completed treatment, whenever the person or couple is interested in starting to have the conversation about building their family, It's prudent of them to undergo a conversation and an evaluation with an REI physician. And this will help determine their likelihood of conceiving or building their family naturally or their likelihood of building their family through fertility treatment.

So just splitting this up from a male and a female perspective, from the male standpoint, we often check a semen analysis. So this is helpful for assessing residual sperm count after. We know from the oncology guidelines that really the semen analysis should be postponed until at least 12 months after treatment and preferably 24 months after the completion of chemotherapy specifically.

And the reason for this is because we do know that chemotherapy and radiation can temporarily, as well as sometimes permanently, have an impact on sperm production. And we know that after 12 months, that's typically the time period in which we would expect to see some resumption of spermatogenesis or sperm production if there is going to be sperm produced.

And the other thing that's important too, is that in male patients that undergo chemotherapy as well as radiation therapy, the recommendation is also to avoid pregnancy for a period of at least 12 months. And this is due to several reasons. So as I mentioned, the recovery of sperm in the ejaculate takes about 12 months after treatment is completed.

But second, we know that radiation and chemotherapy can actually cause mutations in testicular germ cells. So it's really important to know that conceiving a child during this period of time can increase the risk of genetic mutations as well as birth defects in the offspring. So the recommendation from the oncology guidelines is to wait 12 months for pregnancy.

From the female standpoint, we can do what's called ovarian reserve testing, and that's typically done anywhere from about six to 12 months after treatment. And this is a combination of blood work as well as an ultrasound to get an overall assessment of residual egg quantity after treatment. So those are both viable options in order to help decide if natural fertility is on the table or is fertility treatment necessary in order to help build a family?

Peggy: Okay. Wow, this is terrific. So much great information. 

Is there anything else you guys wanna add while we're at this point of the podcast before we get into some anecdotal stories? 

Emily: Quinn, can we talk about what it looks like for somebody who is newly diagnosed? Like if you've got somebody that is really trying to, I know you mentioned that there is a capability of getting them in and getting that fertility done within that two week period for a woman. Can we talk a little bit about what that looks like? What the process is and what someone might expect, and then also what that looks like for a male? 

Quinn: Sure. Let's start this conversation by talking about the female standpoint and then to set the stage for this conversation.

It's important to understand what happens to a woman's eggs over time, so taking back to middle or high school biology. We all know that we're born with all of the eggs that we're ever going to have. And as we all get older, our egg count declines until we reach the age of menopause. So what happens when we hit menopause is that we have very few, if any, eggs that are remaining in the ovaries.

The issue with chemotherapy, as well as radiation treatment, is that it decreases the total number of eggs that we have remaining in our ovaries. So the age of menopause can be earlier due to the total number of eggs being lower at the end of treatment. Sometimes with chemotherapy as well as radiation, our periods can go away altogether.

And that's concerning for the entire egg pool being diminished. So as soon as chemotherapy is done, sometimes people are in menopause. So what causes this, is a question that I'm often asked, and there are many things that can have an impact on the ovarian reserve or egg count. The things that affect us are how old someone is at the time when they get chemotherapy, how many eggs they have at the time before treatment starts, the type of chemotherapy, the amount of chemotherapy.

We know that if you're younger, specifically in your twenties or younger than your twenties, most women will have a lot of eggs, which is good. So there's a higher chance that the treatment is not going to cause that particular person to go into menopause. And there are different ways that we can help figure out egg count before starting treatment, which we alluded to, which include two blood tests as well as one ultrasound test.

And this is really helpful for kind of setting a foundation of ovarian reserve before treatment. Regarding the type of chemo and the amount of chemo as well as radiation. This is something that patients go over with their oncologist as there are some chemotherapies that may have a more of a drastic impact on egg count.

So let's turn the conversation over to what if a patient decides to freeze their eggs? So to walk you through that process. As we know, women naturally ovulate one egg every month. So what we do as fertility specialists when we're helping women freeze eggs. As we help them not develop one egg that month, but ideally develop numerous eggs because there's a really low rate that each egg will eventually turn into a baby if someone was going to use these eggs.

So we try to help the ovaries make lots of eggs. We do this in a two week period of time, and ideally this is done just prior to chemotherapy starting. So that's the important piece of this puzzle. This has to be done before chemotherapy. So we are coordinating with the oncologist as well as the medical team to make sure that this is feasible in order to help the ovaries make those eggs in the appropriate amount of time.

So in order to help us make lots of eggs, we give hormone medications that are given in shot form, and they're about two to three of these injections a day for about 10 days. And these injections are given subcutaneously, which means there's a small prick beneath the skin. They're quite easy to give, and the nursing team helps with that to help show the patient how to give those medications themself.

And what these medications do over the course of 10 days is they help to make the ovaries grow and ideally stimulate a lot of eggs to mature. So during this time in the fertility clinic, we're doing ultrasounds to make sure that the process is going safely. We predict how the ovaries will respond to the meds, but everyone is different.

So we need to do very regular ultrasound monitoring and bloodwork, just to make sure that the process is going safely. I usually tell patients that they should expect about five to six ultrasounds during this 10 to 12 day period of time, and that's what we use in order to monitor the safety of the process.

After we have helped the ovaries make the eggs, and we're done with the shots, two days later is when we do what's called an egg retrieval. This egg retrieval is done under anesthesia and this is when the eggs are actually harvested, and then over the next two weeks, the ovaries shrink. To their normal size.

So it takes about a week or two to feel completely back to normal. In most situations, this two week delay to chemotherapy or radiation does not impact cancer prognosis, but this is where it's very important to have this conversation with the medical team prior to freezing eggs. The timing of this procedure back in the day used to depend on a woman's menstrual cycle in most cases. However, with newer protocols, we can actually start stimulation quite quickly.

So oftentimes after this initial consultation, if a patient is interested in freezing their eggs, they can jump right into the process, which as I mentioned, takes about two weeks in total. The other option here is what's called embryo freezing. So this is the same process. However, instead of freezing eggs on the day that the eggs are harvested, the eggs are then fertilized by sperm.

And then those fertilized eggs or embryos are then grown in a lab for five or six days, and then the viable embryos are frozen, and those can be used in the future to use those embryos. The process is much more straightforward than creating the embryos. The process to use the embryos requires about two weeks of estrogen and progesterone preparations in order to prepare the uterus for pregnancy.

And then we do what's called an embryo transfer, which is where we place one embryo back in the uterus for an attempted pregnancy. In terms of the male standpoint, we know that testicular dysfunction is a potential consequence of cancer therapy as well as radiation. In some cases, there can be extensive damage where we have complete cessation of sperm production, and that's called azoospermia.

So the process of preserving male fertility is much more straightforward than the female counterpart. So that process is called sperm, cryo-preservation, or sperm freezing. And it's a really great option for freezing sperm prior to treatment start. And the nice thing about freezing sperm or eggs or embryos is that they can be frozen indefinitely so they don't age.

From a sperm freezing standpoint, it's ideal that a patient be given a few days, if possible, to bank several specimens prior to starting chemotherapy or radiation therapy. And the goal here is it's gonna allow sufficient time to be able to freeze one or more semen samples if it's needed. The question is, In terms of how we use frozen sperm to build a family, it depends on several different things.

One, how many specimens are able to be frozen before treatment? The other thing that's important is the concentration in motility of sperm within each sample. So depending on the sperm concentration as well as the motility, the frozen sperm can be used in one of two ways. Either through IUI, intrauterine insemination, or IVF, in vitro fertilization.

So IUI is a process where the sperm sample is thawed. It's placed in the uterus at the time of ovulation, and if several vials of sperm are available, then this patient or couple can use this frozen sperm through this process called IUI. In the future, if the sperm count is low, though the success rate of IUI decreases.

However, that's not to say that if the sperm count is low, there is no way to build a family. There is a great way. It's through a process called IVF. And this is actually a very efficient way to build a family. So for IVF, we only need a very small number of sperm required to fertilize the eggs. The nice thing about freezing sperm is that oftentimes the lab personnel can split the sperm sample into several different vials in order to prepare for multiple attempts at fertility treatment in the future. 

Peggy: Well, thank you for that Dr. Quinn. That was very comprehensive. Emily, do you have anything to add to that? 

Emily: Yeah, I mean, as I'm listening to Dr. Katler and just thinking about this with patients that I've helped over the years, I'm just thinking about how fertility preservation is really an insurance policy for the future.

And it may be that the patient is able to get pregnant on their own down the road, that there isn't as much damage to the eggs or to the sperm because of the treatment. But in the case that there may be, or that the likelihood is high, that there will be, it's so reassuring to the patient and to their family that you know that they have this opportunity, should they choose to do this down the road. And just wanted to say that,there is no requirement, right? This isn't to say that if you freeze eggs you must use them or that they must be used within a certain amount of time. So I think it's just, really important to think about, how much hope this can give a person and a family.

A couple potentially a young person who really has an uncertain future, and this gives them something to kind of look forward to. I've had patients tell me that preserving their life is critical. And of course they're grateful to the wonderful teams that do that, but it's also the folks that stop and really give them the time to process the quality of life and the choices that they make, to make sure that their life after cancer can be full and happy and, without the limitations that might be there otherwise. So, I just wanted to reflect on that. And then also just to acknowledge the cost again, and just the barriers that people have. Often there's a lot of sticker shock when they have this initial conversation because, again, most young people in particular don't have thousands of dollars set aside to pay for the treatment to preserve the fertility, and then also thinking about down the road when it's time to actually attempt a pregnancy or to build their family, you know, they may not be able to afford those costs. So again, I just want to reiterate that the resources are there and also the emotional aspect of this.

So I really wanna make sure that listeners know that there are resources available. Whether it's grieving the loss of fertility, or the grieving, just the loss of a certain period of time in your life when you should be out, doing the things that normal 20 and 30 and 40 year old people are doing, or teenagers for that matter.

And you're going through cancer treatment and having to make these decisions that are, as Dr. Katler said earlier, not fair. I just wanna acknowledge that and make sure that folks recognize that there are resources also for psychology or whether it's counseling with a partner, counseling for the patient themselves, families, parents, loved ones, you know, can also be going through feelings of overwhelm and anxiety and worry and concern for the patient and for how the treatments may impact them in the future.

So, I just wanna also reference that and just encourage listeners, if you are struggling with this and you're having a hard time coping because of the fertility impact, to reach out to folks on your team, whether that's your psychologist or your oncologist maybe has a social worker or a behavioral health provider within the practice or within the hospital where you're receiving treatment and seek those folks out because they are really wonderful for processing. Going through, kind of uncovering and exploring. And also for some of the values clarification that happens sometimes. 

Somebody might be thinking, well, I don't know. Should I go through this process? I don't have a partner. I'm not really interested in having kids, but maybe I will be down the road. So it's really helpful to explore some of those questions. Even for someone who's young and may not be thinking about the future, to just stop for an hour of a conversation with a professional who can help guide those discussions. So I just wanted to acknowledge that aspect of this as well. 

Peggy: Well, thank you Emily. 

Quinn: Kind of piggybacking on those comments, another question that oftentimes comes up is there's obviously scenarios in which the time piece to this puzzle is a significant burden, and there are scenarios where the patient can't undergo fertility preservation and the question comes up, or what are the options if you don't have enough time to go through the egg retrieval process or don't have enough time to freeze sperm.

Or if there are significant barriers to that treatment, whether it's the financial barriers which are very real or the geographic barriers. And really the other thing to know, which is an important piece to this, is that there are other ways to build a family. Family building is an interesting journey in that sometimes it doesn't always end up the way that you envisioned it, but there are other ways to build a family. If you're not able to perform fertility preservation prior to treatment start, and you end up having infertility or end up not having sufficient or viable sperm or eggs as a consequence of the treatment.

Just to go through those on a very kind of big picture level. So for men, donor sperm is an option, and this is where men have provided a sperm sample to help others build a family after they have gone through extensive medical screening. And for women, there's the option of donor eggs, which is similar, where a woman has undergone IVF herself for the intention of donating her eggs to a recipient in order to help that recipient build their family.

There's also donor embryos, where a couple that has undergone IVF can actually donate their residual or extra embryos to help others build their family. So the take home message is sometimes fertility preservation is not an option, but there are other ways to build a family that are important considerations for people to always know.

Peggy: Well, thank you Dr. Katler and thank you Emily. This is just tremendous. I'm so happy that we're covering this and talking about it. As we wrap things up, Emily, I think you have a quick story you're gonna share with us. We're gonna leave this on a high note.

Emily: Well, I could tell a whole, I could do a whole podcast of stories cuz I do. 

Peggy: And, and we might do that.

Emily: Dr. Katler's talking about the options. You know, I'm thinking of patients that have had a gestational carrier and I'm thinking of patients that have adopted children, either single children or even siblings and built their families that way. So I'm just thinking of lots of really happy stories right now.

But the one I wanted to just leave was one that came through recently that I was able to reconnect with, and this was a patient that was originally diagnosed at the age of 26, back in 2017, and had a lymphoma diagnosis, Hodgkin's lymphoma. She was treated. She was able to go through fertility preservation.

It was very important to her. Her family was quite large and she was one of many siblings. And it was important to her and to her mom that she had fertility preservation prior to treatment. So she was able to do that. Unfortunately, she relapsed in 2020 during the pandemic of all times and had to undergo BMT, a bone marrow transplant at that time.

But she is now healthy. She's no evidence of disease. She is doing great. She recently got married, which is very exciting. And we've remarked that for her, we don't know what the future holds for her and her husband, but how wonderful for her to, as a survivor of cancer, have this, again, this insurance policy to know that she has this egg saved, for when the time is right for her to build her family and her partner, her husband, together.

It's sort of what we do. The reason we do what we do is to have these true stories of inspiration and hope and to give patients who are going through a really, really difficult time, a glimmer of what life after cancer can hold. And so we're really thrilled to be here. This is a passion of mine.

I have been a nurse now for almost 18 years, and fertility preservation came up for one of my patients early on. It was a question she asked and I was so happy to learn sort of along with her in the journey. And it's become something that I'm really passionate about and unfortunately there are too many families that don't learn about it in time.

I feel really strongly about just advocating for early discussions of fertility and making sure that colleagues in oncology are informed and know what the resources are so that we can really support these people fully. So I'm just really, really delighted that this was a topic that you chose and I hope that this has been helpful to your listeners. So thank you again for having us. 

Peggy: Oh my goodness. Thank you guys for being here. I'm thinking about this young person and how she really had a hand in creating her future and having options and the peace of mind that that gave her, knowing that she did everything she could. With no guarantees, but boy, what a great way to go knowing that you have the options, hopefully. And I'd love to get an update on her down the road, Emily. So, please let us know both of you, thank you so much and can tell that this is something you're very passionate about and it shines through and it's just going to help so many people as they consider all their options during a cancer diagnosis. So thank you again. 

Emily: Well, thank you. Thank you so much, and good luck to everyone listening. We hope that these words could be inspirational and hopeful, and if there's any resources or if we can be of help, I'm here. I'll leave my information in the show notes as well. I'm happy to be a resource to folks that may have questions.

Peggy: Thank you very much. 

Quinn: I'll chime in. Thank you Emily, so much. Obviously a fierce advocate for these patients and you really are a role model and someone that I look up to and have helped so many people in so many different ways. So thank you for everything that you do, and thank you Peggy, for having us. I would like to also thank the National Bone Marrow Transplant Link for the opportunity to discuss this obviously very important and sometimes overlooked subject. So thank you for having us here today. 

Emily: Oh, thank you. Yes, thank you. It means a lot. Thank you so much.