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Share Your Story
About You
First Name
*
Last Name
*
Address
City
State
Zip Code
Preferred Email Address
*
Preferred Phone Number
Age at Diagnosis
Current Age
What type of cancer do youdid you have?
What type of cancer do youdid you have?
-- Please Choose --
Recently diagnosed
Currently undergoing treatment
Finished all treatments
I'd rather not answer
Did you undergo any fertility preservation treatments?
*
-- Please Choose --
Yes
No
No, but I considered it.
If you DID undergo fertility preservation treatments please tell us about your treatment
-- Please Choose --
Sperm banking
Testicular shielding
Testicular tissue freezing
Egg freezing
Embryo freezing
Split cycle (egg and embryo freezing)
Ovarian tissue freezing
Ovarian shielding
Ovarian transposition
GnRH shots
Other
Did someone on your healthcare team speak to you about the possible effects of cancer treatments on your fertility?
-- Please Choose --
Yes
No
I don't remember/I am not sure
If you answered yes to the previous questions who raised the topic?
-- Please Choose --
I did
A member of my healthcare team did
I don't remember/I am not sure
Was the information you received thorough and helpful?
-- Please Choose --
Yes
No
I don't remember/I am not sure
When were you told that your fertility might be affected by your cancer treatments?
-- Please Choose --
Before I started active treatment
During treatment
After I finished active treatment
I was never told
I don't remember/I am not sure
If you DID NOT undergo fertility preservation can you describe why or why not?
-- Please Choose --
I didn't know about it
It was too expensive
I didn't have time before treatment
I already had all the children that I wanted
I couldn't think about it/deal with it at the time
Other
If you DID undergo fertility preservation, please tell us why:
How did you pay for it? [check all that apply]
It was covered by my insurance
I used a financial assistance program
I paid for it out of pocket
I got help paying for it from familyfriends
Other
Questions about post-treatment parenthood
Did you become a parent after cancer?
-- Please Choose --
Yes
No
Not yet but I would like to
If yes, indicate how you became a parent [check all that apply]
My partner became pregnant naturally
I used my sperm that I had banked before treatment
I used donor sperm
I adopted
I became pregnant naturally
I underwent fertility treatments (medications IUI or IVF) to help become pregnant
I used by eggs that I had frozen before treatment
I used by embryos that I had frozen before treatment
I used donor eggs
I used donor embryos
I had a surrogate
I used frozen ovarian tissue
Other
Your Story
In your own words, please share as much as you like about the fertility preservation andor parenthood part of your story:
How did you feel about this aspect of having cancer? Did it affect your spouse, partner or family? Your feelings about yourself? Why did you choose or decide not to take fertility preservation steps? Please include anything that you think might be helpful to other patients or shed light on this issue.
Do you have a video or have you been featured in a news story? Share the link to your video or story here:
I agree to the terms & conditions
*
I agree to the terms and conditions.
Please send us a photo of yourself. Attach File.
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Thank you for sharing your story!
We are starting a program to help connect newly diagnosed patients with survivors who have been through/care about the fertility preservation process. Please let us know if we can follow up with you about this program:
Yes I am interested in speaking to newly diagnosed patients about fertility preservation
No I am not interested in this program
I’m not sure I would like some additional information
Submit