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Expanding Urgent Oncofertility Services for Reproductive Age Women Remote from a Tertiary Level Fertility Centre by Use of Telemedicine and an On-site Nurse Navigator


The objective of this study was to examine a 1-year pilot program aimed at increasing access to fertility preservation (FP) information and services for reproductive-age women newly diagnosed with cancer at a centre geographically remote from a tertiary fertility clinic. An oncofertility nurse navigator (ONN) position was created within the regional cancer centre with the goals of (1) improving local physician knowledge of FP and FP services and (2) improving patient access to FP counselling and services. The ONN identified all women diagnosed with cancer requiring treatment that could impact their fertility and discussed FP options with them and their physicians. As part of a comprehensive program aimed at facilitating access to FP services, the ONN arranged consultations with fertility specialists via telemedicine and coordinated satellite cycle monitoring with a local gynaecologist in order to minimize travel. Patients were surveyed about their reproductive plans, decision-making around FP and experiences with the program. Physicians were surveyed about their engagement with FP services, barriers to FP access and satisfaction with the program. Twenty-two women were eligible for FP during the year-long pilot program. All participated in the study. The most common diagnoses were breast and cervical cancer. At the time of diagnosis, 36.4% of women had no biological children and 68.2% did not desire (more) children. Four women had an FP consultation, and two proceeded with oocyte or embryo cryopreservation. At the end of the pilot program, more physician respondents often or always discussed FP with their patients, stated they frequently refer for FP consultations and stated their patients could obtain FP services in a timely fashion. An ONN within a cancer centre remote from tertiary fertility care can enable access to FP services with minimal need for travel by using local gynaecologic expertise and telemedicine.

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The authors would like to acknowledge the staff at the RCCN, at MSF and at Dr. Siren’s office, specifically Dawn Krawczuk, for all of their hard work caring for these patients without which this study would not have been possible.


This study was funded by the Innovation Fund of the Alternative Funding Plan for the Academic Health Sciences Centres of Ontario, Year VII.

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Correspondence to Rhonda Zwingerman.

Ethics declarations

Informed consent was obtained from all individual participants included in the study. This study was approved by the Research Ethics Boards of Mount Sinai Hospital and the Thunder Bay Regional Health Sciences Centre.

Ethics Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of Interest

RZ has received an honorarium from Ferring. KL has received an honorarium from Serono and is on the board of Conceivable Dreams, a non-profit patient advocacy group. EM has received honoraria from Merck. EG is on the board of Fertile Future, a non-profit patient advocacy group. KM, AS and NL have no conflict of interest to declare.

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Zwingerman, R., Melenchuk, K., McMahon, E. et al. Expanding Urgent Oncofertility Services for Reproductive Age Women Remote from a Tertiary Level Fertility Centre by Use of Telemedicine and an On-site Nurse Navigator. J Canc Educ 35, 515–521 (2020).

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  • Fertility preservation
  • Oncofertility
  • Telemedicine
  • Nurse navigator