The oncofertility process begins when a patient initially presents to the oncology or bone marrow transplant (BMT) program for diagnosis and treatment of their underlying disease. The primary oncology/BMT team contacts the fertility navigator to initiate the fertility consult and risk assessment. Initial consultation can occur by phone and communication via the electronic medical record or by e-mail. By creating a separate specific e-mail address, the consulting team has an additional streamlined way to reach our team.

The goal of our oncofertility program is to see all patients new to the oncology and BMT division. However, we recognize that not every patient will be an appropriate candidate for a discussion on fertility preservation. A patient may be deemed ineligible for the following reasons:

If a new patient meets one or more of these criteria, we will meet with the primary medical team to discuss whether or not it is appropriate to approach the family about fertility preservation options. Certainly some families who seem ineligible by criteria alone have many questions regarding future fertility. Patients who are acutely ill at the time of presentation and require immediate oncologic treatment will have the fertility consult delayed until the patient’s medical condition is stable and timing is appropriate. This decision is always made in conjunction with the treating medical team. Patients who have previously had a fertility consult (relapse, transfer of care) may have an abbreviated consult to ensure all fertility preservation needs have been met.

Once a patient is classified as eligible, the fertility navigator contacts the oncofertility pediatric oncologist to perform the risk assessment. This physician will discuss the proposed treatment plan (surgery, radiation, chemotherapy) and timeline with the primary medical team. He or she calculates a patient-specific infertility risk assessment (low, intermediate, high). This is done using a cyclophosphamide equivalent dosing (CED) calculation and radiation/surgical risk assessment with published dose guidelines [1].

The risk assessment is then communicated back to the fertility navigator and documented in the electronic medical record. She advises the gynecology/urology team of the consultation. The fertility navigator facilitates timing of evaluation and testing for the patient to ensure all parameters are met in accordance with the fertility preservation and cancer treatment plan. In addition to the consultation with the provider and fertility navigator, the patient and family receive written information on the fertility preservation options available to them. Many families would like time to think about their decision prior to making a final choice. Thus, the fertility navigator reconnects with the family after 24–48 h and then begins to coordinate any necessary procedures or referrals. The consult is completed and documented in the electronic medical record using a standardized format. The primary medical team is updated regularly throughout the process to maintain good communication and best care for the patient (Fig. 15.1).