Under the heading “Cancer and becoming a parent”, the German Foundation for Young Adults in Cancer is pushing for the reimbursement of fertility-preserving activities for cancer patients by the public health insurances.

The German Foundation for Young Adults with Cancer is calling for the amendment of §27 in SGB V. Thereafter, the costs for the removal and cryopreservation of the germ cells of young cancer patients should be covered by the health insurance companies. This would constitute considerable relief for the young victims – especially in the situation immediately after the diagnosis.

Since August 2018, there has been a draft bill from the German Federal Ministry of Health. In the draft of the law for faster appointments and better supply (Terminservice- und Versorgungsgesetz – TSVG), the topic of fertility preservation of cancer patients can be found in point 11.

On the December 13th, 2018, the first reading to the TSVG took place in the Bundestag. On January 16, 2019, the first hearing of the law in the German Federal Health Committee followed. The second hearing in committee is set for February and the 2nd and 3rd reading is scheduled in March.

Background

The cure rate in young adults with cancer aged 18 to 39 years is about 80 percent. Due to the at times very intensive treatment – for example in the form of chemo and/or radiotherapeutic interventions – damage to germinal tissue (ovaries/testicles) and germ cells (oocytes, sperm) can occur and thus result in an irreversible loss of fertility.

Medically established

There are well-established medical methods for fertility preservation, for example, by obtaining, freezing and storing (cryopreserving) of egg cells in female patients and recovering, reconditioning and freezing sperm in male patients. For medical reasons, the fertility treatment measures must be taken before starting the treatment. The (time) pressure is often very intense. The young patients often experience the diagnosis as a catastrophic collapse of their previous life perspectives. The disease affects people who have not yet dealt with the question of their own family and children. Appropriate provision through fertility-preserving measures would enable many cured cancer patients to have their own children later in life.

Problem of reimbursement

However, the German Social Code V (SGB V) does not provide funding for the various methods of fertility preservation as a central set of rules for publicly insured persons. The lack of reimbursement leads to very special emergencies. Because the costs often can’t be covered by the young patients. Thus, financial contributions of between € 3,500 and € 4,300 are necessary for the removal and freezing of egg cells for women and € 500 for the removal and freezing of sperm in men. In addition, there are annual costs for storage of about € 300.

New publication by foundation und expert association

Together with the DGHO German Society for Hematology and Medical Oncology e.V., the German Foundation for Young Adults with Cancer created the 11th volume of DGHO’s Health Policy Series “Cured of cancer, but not healthy. No hope for their own children.”

The volume of the health policy series deals with the following questions:

• Cancer, fertility and loss of fertility
  • Young women (surgery, chemo, radiation, hormones)
  • Young men (surgery, radiation, chemotherapy)
• Medical methods to maintain fertility and the question of funding
  • Young women (collection, removal and freezing of egg cells, harvesting and freezing of ovarian tissue, storage options)
  • Young men (extraction, processing and freezing of sperm, extraction and freezing of testicular tissue)