Fertility Preservation Decisions, Part 2

Fertility preservation is not always the first thing a family thinks about during a serious illness. But fertility preservation can shape a patient’s future in important ways.  

In this episode, Tekeima Townsend-Billups, MDiv, and Kari Bjornard, MD, talk with cancer survivor Keragan about her experience of going through fertility preservation years after completing cancer treatment. Keragan was diagnosed with Stage IV Hodgkin lymphoma at 17 years old.  

Now 25 years old and an emergency room nurse, Keragan shares her journey with fertility after cancer, including what she wishes she had known at the start of treatment. Kari offers insights into risks, timing, and how to talk with your care team. Tekeima guides the discussion that covers the emotional impact of these decisions, differences between male and female patients, and the many ways to build a family. 

A special thank you to our host, Tekeima Townsend-Billups, senior staff chaplain in Spiritual Care at St. Jude; our expert Kari Bjornard, director of the Fertility Program and assistant member of the Oncology faculty at St. Jude; and St. Jude patient Keragan. 

This episode was recorded on June 26, 2026. Listen to the first part of this conversation on male fertility preservation decisions.  

Learn more about Keragan’s diagnosis of Hodgkin lymphoma on St. Jude Care & Treatment and Together by St. Jude™. 

Learn more about female fertility and mental well-being on Together by St. Jude™. 

St. Jude does not endorse any branded product or organization mentioned in this podcast.

Episode Transcript

Narrator (00:01 – 00:37)
A child's diagnosis of cancer or another serious disease is difficult. Families, guardians, and loved ones experience a range of emotions and often need support related to their child's diagnosis and treatment. St. Jude Children's Research Hospital brings you Caregivers SHARE, a St. Jude Podcast. Share stands for support, honor, advise, reflect, encourage. In this series, you'll hear stories and insights directly from the experiences of St. Jude families and care providers. 

Tekeima Townsend-Billups (00:37 – 02:10)
When a child is facing a serious illness, some medical treatments can affect their ability to have biological children later in life. But there are ways to preserve fertility and protect that possibility. Even still, conversations about fertility preservation can feel overwhelming as they often arrive in the midst of uncertainty, fear, and urgent decisions. Yet they matter deeply because they impact not only the body, but also identity, possibility, agency, and the hopes one carries for their future.  

I'm Tekeima Townsend-Billups, lead chaplain at St. Jude Children's Research Hospital. And in this episode of Caregiver SHARE, I'm joined by Keragan Casey and fertility expert Dr. Kari Bjornard as we explore what it means to preserve female fertility when a child is facing a serious illness, making space for both the clinical realities and the deeply human experiences that surround them.  

After listening today, if you're interested in hearing another perspective, we invite you to listen to our previous episode, Fertility Preservation Decisions, where we explore the topic through the experience of a male patient. Today we're holding space for all who are impacted and hope that you feel seen and valued here. Kari, will you please introduce yourself? 

Kari Bjornard (02:11 – 02:54)
Hi, I'm Dr. Kari Bjornard, and I am a solid tumor oncologist here at St. Jude Children's Research Hospital. And I also am the director of our Preservation of Reproductive Health program. As part of that program, I sort of think of our role as threefold. The first being to talk about what the risks of cancer diagnosis and its therapy are to infertility in the future. The second is to offer fertility preservation techniques or options for those who are at a substantial risk. And lastly, to follow patients through their cancer journey and into survivorship to let them know how therapy might have affected them and whether there are any additional options they could pursue. 

Tekeima (02:54 – 03:04)
Thank you, Kari. We're so grateful for your expertise and presence. Keragan, will you please introduce yourself as well and tell us a little bit about your journey? 

Keragan Casey (03:05 – 03:51)
Hi, my name is Keragan Casey. I work as a nurse in an emergency department. At the age of 17, I was diagnosed with stage four Hodgkin lymphoma. I found out due to an OBGYN coming to my high school and talking to us about where we need to look on our body for any lumps or bumps.  

Now, five years later, I'm in the survivorship clinic, and that's when I first heard about fertility. I was told we could go ahead and look into my fertility levels to see where I was at and if I was going to need any treatment or any other options in case my levels were lower. I had my AMH drawn, and that's when I realized I need to be looking into fertility options. 

Tekeima (03:53 – 04:34)
Keragan, I first want to thank you for trusting us with very sensitive parts of your lived experiences. I don't know if you feel courageous, but as I listen to you share and anticipate more that you will share, I was reminded of Mary Anne Radmacher's quote that says, “Courage doesn't always roar. Sometimes courage is the quiet voice at the end of the day saying, I will try again tomorrow,” which is what you've done the past several years of your life. Thank you for being here with us.  

Kari, can you share some basics about female fertility preservation during serious illness? 

Kari (04:34 – 05:52)
Absolutely, and I think the first thing to know about fertility preservation and talking about the risk of infertility is that this is very individualized depending on a patient's specific journey, characteristics, and even potentially where they are when they're diagnosed.  

So the first thing I'd like to point out is that not all cancer treatments affect fertility. That can sometimes be a misconception that any cancer treatment may be detrimental to fertility in the future, but not always true. So it really depends on what the treatment looks like, including which chemotherapy agents are used, the doses of the chemotherapy agents, and also whether there's other care, including radiation therapy or potentially even some surgery.  

There are other aspects that we consider as well, including the age of the patient at time of treatment. And I don't mean necessarily whether they're 8 versus 9 years old, but more thinking about developmentally, is this a pre-pubertal patient or is this a post-pubertal patient? Because the body may be more susceptible to potential side effects from chemotherapy or other therapies at that time, or it may affect what options we're able to offer that patient in the future. 

Tekeima (05:52 – 06:02)
Thank you. Keragan, how did you first learn about your condition's impact on fertility and the option to go through fertility preservation? 

Keragan (06:02 – 06:35)
I was at a survivorship clinic appointment, and they were explaining to me all the benefits I had at this clinic and what I could look into. And she brought up fertility, how it could just be as simple as a blood draw to see where I was at. And if that was something I was interested in, we could just go ahead and add it on to my labs. And then the next time I'm here, I can go and sit down and talk to the fertility people. And so I went ahead with that and then had my labs drawn. 

Tekeima (06:35 – 06:56)
Hearing you describe that experience, I'm struck by how much you were carrying at such a young age. I can't imagine the weight of it all in reality. Can you take us back to some of those early conversations and let us know what you were thinking and feeling? 

Keragan (06:56 – 07:47)
When I got my AMH (Anti-Müllerian Hormone) level back, it was way lower than I expected. I was expecting to be at about a 2. I wasn't expecting the treatment to have messed with my fertility as much as it did.  

So when I did get the results back, it was very crushing. I felt like I had failed as a woman in an aspect that I'm not even ready for yet. And that was hard for me to understand. I feel like I had failed as a partner in an aspect because I didn't have all of the information yet. It wasn't that I couldn't get pregnant. It just might be a little harder. And that was a toll in itself. 

Tekeima (07:47 – 08:17)
I want to honor what you said you were feeling about failing as a woman and not rush past the grief and disappointment to the next question. As you were trying to make sense of it all with a great deal of mental and emotional heaviness, what or who helped you carry it? And what did their presence mean for you? 

Keragan (08:17 – 09:23)
A lot of it was my mom and my boyfriend. When I found out I was sitting in the car with my boyfriend and I just started crying and I gave him an option to leave because I felt like I was taking a fair chance away from him. And he stood by my side and just let me know, this is nothing that you've done. It's just the cards you've been dealt. And you just have to play the cards you're dealt.

And my mom was very understanding to the feeling as if I failed as a woman. My mom has four kids. Getting pregnant was not hard for my mom. And to see me struggle feeling as if I failed made her see a different side to me because my mom has not had to experience failing as a woman in the fertility journey. And that was never a thought in our eyes pre-treatment. We didn't even think about fertility. And so now seven years down the line, it's a problem. 

Kari (09:23 – 09:39)
So Keragan, you just mentioned that you didn't really think about the effects, you know, or the potential effects at diagnosis. Do you remember hearing anything about the potential for chemotherapy to affect fertility or your reproductive health in the future at diagnosis? 

Keragan (09:39 – 09:58)
No, I think it was such a whirlwind that that wasn't even talked about. And when I came to this hospital, we did scans and they were like, you have stage four cancer. I think fertility was the last thing on anybody's mind. 

Kari (09:58 – 11:27)
And I know as, you know, in my role as part of the fertility program, one thing that we do hear from a number of patients who have survived their cancer and come back to us, comment a lot on how they don't remember the conversation or having this conversation at the time of diagnosis. And I think that for many patients that can be for a couple of different reasons.  

One, depending on when they were diagnosed, you know, if they've been a survivor now for a number of years, their diagnosis might have been, you know, sometimes up to 10 years ago. And a lot less was known about how therapies affect fertility at that point. And there was just less of a sort of focus for many institutions on giving this information at the time of diagnosis.  

Secondly, Keragan, you just, I think, hit the nail on the head talking about a whirlwind at this time of diagnosis where you're getting so many pieces of information, there's so many things happening that even if someone does give you some information, sometimes it just doesn't penetrate or it just immediately falls out of your brain because it's replaced with something else. And I think that's very normal and sometimes can happen not only for the patient, but also for the parents who are also carrying that weight at the same time. But then also there's that pressure of I have a cancer, I need to get going on therapy and just sort of skipping right past some of these other important conversations that could be had at that time. 

Tekeima (11:27 – 12:03)
Sounds like a gift to have someone on the team who is aware of the acute needs and can journey with you in that space and also hold the importance of something that you may want in the future. So we appreciate your work, Kari, and know that deciding to preserve reproductive materials can be deeply personal. Sometimes patients and parents don't see eye to eye. Can both of you respond to this question or share thoughts about navigating these situations? 

Kari (12:03 – 13:34)
Again, from my role as the medical director for our fertility program, we've had this happen a couple of different times. And typically what we have sort of seen in our experience is that the patient and the parent will have just different ideas about how they want to go across or deal with this issue. Some of them can be because parents are very eager to protect the health of their children and sometimes can be very eager to go ahead and start therapy.  

But the opposite sometimes can also be true where an adolescent or young adult is very adamant that they don't want to have a procedure done or they don't see themselves having children in the future and don't feel like this is an important step for them to take, whereas parents might want all options available for them.  

So for us, when this issue arises, we have some other sort of tips and tricks up our sleeves. The first is just being honest and having open and honest conversations with both the patient and caregiver, not only of what the risk is, what the fertility preservation options are, but what those entail and what it will allow them to do in the future.  

But sometimes when there's still that tension and patients and caregivers are not seeing eye to eye, we've brought in some other individuals or third parties to help. This could be potentially a chaplain or someone from child life or even a family friend or a personal friend that can be helpful in mediating that conversation and sort of getting everyone on the same page. 

Keragan (13:34 – 14:53)
For me, I was 17 at the time, and as much as I wish somebody would have talked to me about fertility right as I was getting my diagnosis, when I was 17, I wasn't thinking about children. I wasn't thinking about 10 years down the road, you know, this could be a problem, could not. We're not 100% sure.  

And looking back, I wish I could sit my 17-year-old self down and just slow down because, yes, what I heard at 17 was very devastating and it would alter my life forever. I think the effects of the treatment alters your life more than the treatment itself.  

So I wish I could sit someone my age down and just say, hey, just because you don't think you want kids right here at this moment, don't take away the chance for yourself in 10 years when you do want kids and it's too late. And now there's someone could be in a way worse standpoint than I was in and have absolutely nothing, all because they didn't just take the time, even 10 minutes, and think about, hey, you know, this could affect your life. 

Kari (14:53 – 15:52)
One important aspect, though, I think, that you're sort of getting at is this also doesn't have to be a one time conversation, that we can engage with patients or their families, not only a diagnosis, but perhaps the opportunity was missed. Well, we could still have that conversation while you're on therapy. Maybe the options for fertility preservation are not the same, but the delivery of information so that you feel empowered to make decisions, that's really important throughout the cancer journey. And that doesn't stop once your diagnosis is over and your treatment starts.  

You also have the survivorship period. And I think here, again, you're a powerful example of sort of reintroducing that conversation in the survivorship era and then being able to make decisions based on that to, you know, sort of shelter the hope that you have for your future and for whatever family-building hopes you have as you emerge into adulthood. 

Tekeima (15:52 – 17:15)
And another part of what you said, Keragan, about sitting your younger self or even those who are experiencing the same thing down to share some thoughts, hindsight is 20/20. And here, this is an opportunity that you are doing that. This podcast will be heard by many people. And I do believe those individuals who need to hear some of what you're saying will be a part of the audience.  

And as I listened to you both, I was also reminded that these moments ask so much of patients and families. And while decisions may differ, every family is trying to make the most loving decision and the most thoughtful choice they can with the information they have at the time. There isn't just one path of navigating this. There's only the deeply human work of making difficult decisions in the face of uncertainty while holding on to hope.  

Many caregivers and patients hesitate to ask their care team about fertility preservation, even if it's on their minds. Kari, how would you suggest bringing it up if the medical team doesn't? 

Kari (17:15 – 18:51)
That's a great question, and of course we hope and think of our oncology providers and medical providers as sort of being these omniscient people who know all of the things and will make sure that they tell the patients and families all of the important things about their care.  

But as you mentioned, the deeply human work, humans sometimes make mistakes or omissions, and sometimes that doesn't happen. Because physicians also and the rest of the care team, our main goal is to try and start treating the cancer and to get our patients back on a journey towards health.  

So for patients who maybe feel like they're resonating, Kari, again, with your thoughts of, man, no one told me at diagnosis. It's not coming from a place of, oh, well, I don't want to deal with that with my patient. Really it is, I want my patient to get back on their feet and let's treat this cancer.  

So for those patients and families who are thinking, hmm, I don't remember hearing this from my care team, the simplest way is just to ask, I heard that cancer treatments and even a cancer diagnosis might affect my or my child's fertility in the future. What do you know about that? What resources do you have at our hospital for fertility preservation, or is there someone else I can talk to about more in-depth conversations or questions that I might have?  

Not every hospital or clinic has the same resources. So there certainly are some educational resources online, but I think the best place to start for what's available near you is, again, that simple question to your care team. 

Tekeima (18:51 – 19:29)
Thank you, Kari. This is very good practical advice and guidance. In moments that can feel daunting, knowing how to begin the conversation can help families from feeling uncertain to feeling more empowered and prepared to advocate for the questions and concerns that matter most to them.  

Kari, in a previous episode, you talked with a male patient about preserving fertility. Are there any special considerations or emotional experiences that are unique to female patients as they consider fertility preservation? 

Kari (19:29 – 23:47)
Thank you for this question, because I think this is an important one. And I want to start by backing up a little bit and referencing something that Keragan was talking about when she mentioned the lab testing that she was getting to check her fertility.  

Now, much of that depends on when we're seeing patients. And when I mean that, I'm talking about, are we seeing a patient at the time of diagnosis, or are we seeing a patient in the survivorship time point after they've received their chemotherapy or a cancer treatment?  

So if it's at the time of diagnosis, we think most patients should have relatively normal fertility for age. They are growing up and haven't had any, what we consider to be insults, meaning detrimental treatments or medications that could harm their fertility. And so if we have a patient who we think of as having a real risk to their fertility from their cancer treatment, and we have a fertility preservation option, we can offer that right away without oftentimes doing a lot of other testing. And we can send them to our reproductive and endocrinology associates to do egg freezing, for example.  

For patients who have already received their cancer therapies and might be at risk for treatment-related infertility, sometimes we do more testing to find out if this is an appropriate patient to actually put through the fertility preservation process.  

One of those tests is a lab test called AMH, or Anti-Müllerian Hormone, and that's what Keragan was referencing in her survivorship clinic visit. And that test can help us sort of get an idea compared to other young women the same age what we call ovarian reserve looks like. And that is a sort of a simple way of saying, does a patient's ovaries have an adequate number of eggs in them that we can actually retrieve some and save them for the future? Sometimes we'll do that lab testing in conjunction with other hormones, and sometimes an ultrasound even to look at the ovaries and count follicles or the fluid-filled sacs that eggs sit in. And those are all things that you may have your care team order as they're sort of doing these workups for fertility preservation.  

But I also want to walk through what that fertility preservation process looks like because it can be distressing for some patients and families. If we have a patient, again, this could be at the time of diagnosis or in survivorship where we're considering egg freezing on, for example, that process involves oftentimes sending to an adult fertility clinic where they do this more frequently as part of in vitro fertilization or IVF therapy.  

As part of egg freezing, oftentimes patients are prescribed one or two hormones that they will be giving to themselves via injection for several days, and they'll often then have to go back to the clinic to get labs drawn and ultrasounds every few days to see how their ovaries are responding to the medications. And then when the fertility doctor feels that they are ready to actually retrieve the eggs, this is a procedure that's done under anesthesia, depending on what your fertility clinic looks like. This might be in a hospital operating room or potentially an outside surgical center procedure room.  

And eggs are collected through a transvaginal ultrasound that, again, you're asleep for, and they attach a needle onto the ultrasound probe that goes through the vaginal wall, and they drain the fluid-filled sacs or follicles in each ovary, and with that fluid comes the eggs, and then they're able to look under the microscope to determine how many eggs were collected, how mature they are, and then can decide how many they're able to freeze.  

So for some young women, the idea of doing a transvaginal procedure can be very distressing, and for some, elicit some very emotional responses that oftentimes we have to prepare them for or talk about so that they are empowered to decide whether this is right for them. 

Tekeima (23:48 – 24:04)
Thank you, Kari. As you were sharing, I was also just observing you, Keragan. Did you have any thoughts as Kari was sharing the educational aspect of fertility preservation? 

Keragan (24:04 – 27:22)
I do think the transvaginal ultrasound is scary. Even at 25, I couldn't imagine being 17, because at 17, I don't even think you go to the OB-GYN yet. I think your first appointment's at 18.  

And so walking into a clinic that's not this hospital where I'm comfortable at was a little bit uncomfortable. And having just to see other patients who aren't going through what I'm going through, but are still having to go through IVF and watch their struggles, it's kind of a sad place. And a lot of people, there's a lot of hope in those clinics. And with especially all the hormones everybody's on, it can be more triggering.  

I think a lot of this procedure kind of gave me a lot of PTSD from when I was diagnosed in 2018. A lot of this was very mental for me. And I don't know anybody, like none of my friends have gone through IVF or have gone through an egg retrieval. And so I was not sure what to expect. And I think that was hard, because everybody's experience is different. And a lot of, like I've looked it up on TikTok, because TikTok is the big thing right now. And a lot of people were happy-go-lucky with this. A lot of people also want a baby as they do an egg retrieval and IVF.  

That wasn't necessarily my experience. I was very down on myself and my mental health was not okay. I wish I would have had someone I could talk to about this, someone that maybe had also gone through it, or just like a, hey, heads up, this isn't all butterflies. And as someone in my position, any type of hospital setting isn't always butterflies anyway. And so having to go through another surgery, another treatment for something you have no control over is very hard.  

Now I do think if you're in a position like mine and you do go through something like this, I think you should go ahead and do the egg retrieval. It's only 2 weeks. And that's what I had to keep telling myself. It's only 2 weeks. And when I would go through treatment, I would count down my rounds. I have five rounds left, four rounds left. Okay, I'm almost there.  

And I kind of had to put myself in the same mindset of, okay, you only have 15 more days, 14 more days. You can make it 14 more days. And I think I wish I had a bit more education on not necessarily the procedure, because I looked that up on YouTube and that was gnarly, but what these hormones could do. Because when I went to the clinic, of course, I read the paper of, hey, this could possibly happen. And I was shocked by the effects it had on me. 

Kari (27:24 – 27:27)
Who did you bring with you to your appointments?

Keragan (27:27 – 28:19)
Nobody. And I think that was another thing because you can't have anybody back there with you. And I would have brought my mom. My mom drove me down, but there was no point for my mom to go sit in the waiting room with a bunch of other women. And so she would sit in the car for my first and maybe second. And then I just drove myself because I was here Monday, Wednesday, Friday, I believe. And so that's a lot to drive. And I had to be off work. And I think that was another toll that took on me is I didn't have my normal environment. I was taken out of my workspace and I love being at work. All my friends are at work. So after I would get home, I would just sit there. And then I wish I would have taken my mom with me and just made her sit in the waiting room. 

Kari (28:19 – 28:43)
Keragan, you and I have had a different conversation once where I asked you this question. I'm going to ask it again for the audience. One of the things that I mentioned was that oftentimes these fertility clinics, they're adult-focused clinics. And you, I guess we'd consider you a young adult, but how did it feel for you to be in that sort of adult-focused clinic compared to what you had been used to?  

Keragan (28:43 – 29:25)

It was uncomfortable. It was, I didn't know what to expect when I walked in. I wasn't sure how everybody else around me was going to feel. And as I walked in, you check in and then you sit in the waiting room. And then once you get called back, there's actually another waiting room where it's just a bunch of women. And I think a lot of it was everybody was just sitting there playing crosswords, reading, everything like that. And I was just kind of sitting on the edge of my seat the whole time. This is, I had no, I had no idea what to expect. And it's a very different environment from what I'm used to here at this hospital. And I think that was definitely weird. 

Kari (29:25 – 31:27)
And so again, you know, in our fertility program, when we're seeing patients and we're sending them for egg retrieval, we try and prepare patients as much as possible. But, you know, Keragan said it herself that she's a little bit older and this is uncomfortable for her. So imagine the younger patients, if they're 17 or maybe even 15. And sometimes we have post-pubertal girls that could be eligible for this, even younger than that.  

So this is where we try and really talk through this with our patients and families so they can determine if it's right for them. You know, this is just one potential option for fertility preservation. We do have a couple of others. Some of this will vary depending on your cancer institution and what other available resources you have at your hospital or your particular clinic.  

But I do want to mention that there's a couple of other things out there, including what we call ovarian suppression therapy, which can be using hormones with the goal of sort of turning the ovaries off so that they're not as active and hopefully don't sustain as much damage from chemotherapy. The jury's sort of out on whether that truly is helpful or not. And there's currently studies ongoing to help determine the answer to that.  

There's also something called ovarian tissue cryopreservation. This can be an option for pre-pubertal girls that otherwise can't do the ovarian stimulation and egg retrieval. And in ovarian tissue cryopreservation or freezing, typically ovarian tissue, oftentimes an entire ovary for young people is taken out surgically and frozen for potential use in the future.  

So these are current options that we have and hopefully we'll continue to develop new options that may come online for different populations as we move forward.  

Another option may be a wait and see approach. This may be appropriate for patients or families that don't want to pursue another option or who don't have time potentially before therapy starts. 

Tekeima (31:27 – 31:55)
This conversation has surely revealed that there are so many layers that patients and families experience while facing this. And I'm glad, Kari, you brought up the additional pathways to parenthood because I'd like to ask you, Keragan… We know that biologically is one way to become a parent, but what does it mean to build a family for you? And how do you weigh what's important? 

Keragan (31:57 – 32:32)
What it means to me to build a family isn't necessarily if I gave birth to that child. It's how much I love the child, how much I love anybody I bring into my home. To me, that's what makes a family. It doesn't matter biologically if you're mine or not. That's just how I was raised. There are people with different views, but I know I would be a great mom if the opportunity came one day, whether it was my child or not. 

Kari (32:32 – 33:42)
So I should mention that we counsel every patient that even if you undergo a fertility preservation option, that doesn't guarantee the ability to have a biologic child in the future. So one of the things that we also talk about are alternative family building options.  

This can range from things like donor eggs, so getting eggs from another person, embryo adoption or donor embryo. So this is an already fertilized egg that can be implanted in someone's uterus to have a biologic pregnancy in the future. There's also adoption. And depending on the patient, their religious or cultural beliefs or their personal situation, all of these could be options for them in the future. And it's important, I think, to talk about those and normalize them.  

Because I think the audience should also know that infertility is actually very common in the general population as well. And so sometimes this may not be related to a cancer diagnosis or cancer therapy, but unfortunately may be part of someone's story as they move forward through life anyway. 

Tekeima (33:44 – 34:16)
Thank you both for sharing your responses to that. Every family's story truly does begin differently, but they remind us all of the same truth. A family is born of an undeniable, abiding and steadfast love that holds it together. And wherever that kind of love takes root, something wonderfully sacred begins to grow.  

Do you two have any final thoughts that you would like to share with our listeners today? 

Kari (34:16 – 35:04)
Well, first I'd like to thank Keragan for her story and for her thoughts and sharing with us. And Tekeima, also you for moderating this conversation. That's really been a fun experience to have.  

But I think our audience should really understand that it's a very personal decision, whether they want to move forward with fertility preservation or how they want to build their family.  

And as part of a care team, we all want to be here to help you, the patient, the family, to see your dreams come true. And so again, just having an open dialogue with us about what you're hoping for so that we can be honest and also connect you with resources that you might need to achieve those dreams. 

Keragan (35:05 – 35:24)
And Dr. Kari, I would like to thank you because my journey with infertility isn't necessarily over, I'm just halfway through. And being on this podcast to share my story has actually given me a lot more knowledge about what I could go through in the future that I didn't know any information on. 

Kari (35:25 – 37:40)
So that's an incredibly powerful thing to say and I thank you for telling me. And that actually reminds me to finalize a few other things, mostly because Keragan, you're right, even doing fertility preservation, again, that's one point in time. And if you need to use those materials in the future, that's an entirely separate journey or at least a continuation of that journey.  

And one thing that sometimes can be challenging to think about is what a patient or family needs to prepare for to be able to use those in the future. Unfortunately, here in the United States, that oftentimes means a monetary plan for how you're going to pay for that use. Right now in the United States, not every state has mandated insurance coverage for being able to use reproductive materials for having children in the future. And so sometimes thinking about that plan of if I need to use this, how could I go about doing that? That is really important.  

The second, reproductive materials, once they're collected, whether they're eggs or sperm, they need to be frozen and then stored long-term. Individual fertility clinics usually help coordinate that freezing process and sending them to a long-term storage facility. That can look differently depending on what your clinic is offering, whether it's local or they send them to another site in the United States. But oftentimes that requires annual storage fees and sometimes you can pay several at once.  

But again, keeping track of just where are your materials, or where your children's materials, who is paying that bill, when is it due? If I moved or changed my phone number, have I updated my information at that third party site so that if they need to reach me, they can? That is really important as well. And important to impart that information to the child as they get older so that they can take that over and know if I need to use my reproductive materials, where are they? Who do I contact to get them? And how do I tell my fertility clinic or fertility provider in the future what I have so that they can help me plan for what my options are? 

Tekeima (37:41 – 38:53)
Thank you both for your time, intention, and vulnerability. Your voices have undoubtedly brought clarity, courage, and compassion to a conversation that so many families carry quietly.  

And to you our listeners, thank you for allowing us to walk alongside you. Whether you find yourself on a similar journey, supporting someone you love, or simply seeking to understand, we honor your presence here.  

If this conversation revealed that you would benefit from a safe space to name and reflect on your own experiences, I encourage you to seek additional support from someone you trust, a licensed mental health professional or your spiritual leader. And if neither of those are available, text or call the Suicide & Crisis Lifeline at 988, where caring counselors are always available to respond to life's most difficult moments. Until next time, be gentle with yourself and know that even beyond this moment, we're holding space for you. 

Narrator (38:53 – 39:48)
Thank you for listening to Caregivers SHARE, a podcast lovingly brought to you by Patient Family-Centered Care and Psychosocial Services at St. Jude Children's Research Hospital.  

Please subscribe, leave a comment, and share this podcast with others who may benefit from this support. Visit stjude.org/caregivers-share for show notes and educational links related to each episode.  

This podcast is for informational purposes only and does not render medical advice or professional services. This podcast does not establish a patient relationship between the listener and St. Jude Children’s Research Hospital. The opinions expressed belong to the caregivers. Your personal experience may differ. If you have questions about individual health concerns, psychosocial needs, or specific treatment options, please discuss them with your child’s medical team.   

Accuracy and availability of Caregivers SHARE, a St. Jude Podcast transcripts may vary. Transcript text may be revised to correct errors or match updates to audio. Audio on stjude.org may be edited after its original publication. The authoritative record of Caregivers SHARE, a St. Jude Podcast episode content is the audio record.