Q&A with Jennifer Levine, MD, MSW: Preserving choices for cancer survivors - Children's National

For children and teens with cancer, fertility preservation can offer something powerful: choices for the future. At Children's National, Jennifer Levine, MD, MSW, helps families understand how treatment affects fertility and which options are available.

An internationally recognized expert in survivorship medicine, Dr. Levine directs the Comprehensive Cancer Wellness Program, working with specialists across Children's National and beyond. She led the development of pediatric fertility risk assessment guidelines and is helping update them.

Here, she explains why access is challenging, what her research is revealing and how she hopes to make fertility preservation a routine part of pediatric cancer care.

Q: What drew you to fertility preservation research?
A: I wanted to help families navigate a complicated system during an already overwhelming time. Fertility preservation can seem straightforward, but access requires care teams, researchers, education, policy and hospital systems to work together.

Q: Why is fertility preservation important for young patients with cancer?
A: Survival comes first, of course, but pediatric cancer care also has to look ahead to life after treatment, including whether therapy could affect a patient's ability to have biological children in the future. When there is a risk, families should have an opportunity to understand their options and protect future possibilities.

Q: What are the biggest barriers to fertility preservation care?
A: Awareness has improved dramatically over the past 25 years, but it remains inconsistent. Cost is a major hurdle. Insurance coverage varies widely, and families may face preauthorization delays, confusing billing or out-of-pocket expenses. Timing is another significant challenge.

Q: What is your research helping us better understand about fertility preservation?
A: Much of my research examines what keeps young people from receiving care and how we can make it easier to obtain. Right now, I'm looking at costs from both a big-picture view and from what families experience directly. I work with other researchers to analyze insurance data to understand the financial burden on families. I also lead and contribute to studies that follow in real time what happens when families seek fertility preservation. One Children's National study, funded by the Rally Foundation, is helping us understand the real-world insurance process and costs of sperm banking. Together, this work is affirming that access is shaped not only by whether fertility preservation is medically possible, but also by timing, coverage, out-of-pocket costs and the systems families must navigate before treatment begins. I am also researching ways to protect fertility. I co-lead a national Children's Oncology Group study of whether a hormone-suppressing drug called Triptorelin can protect ovarian function in teens and young adults receiving chemotherapy.

Q: Why does the insurance research focus on sperm banking?
A: Sperm banking is generally the simplest and least expensive fertility preservation option, making it a practical starting point. My colleagues and I have advocated for all post-pubertal males to have the opportunity to bank sperm, regardless of their estimated fertility risk, because that option might not be available later.

Q: What makes risk assessment so difficult in children?
A: It is not always possible to predict who will experience infertility. Risk varies by diagnosis, treatment, age and sex. Some patients are clearly at low or high risk, but many fall into a gray area. Cost makes that uncertainty even harder for families to navigate.

Q: How does Children's National support fertility preservation care?
A: We have a strong cancer wellness team, powered with help from philanthropy. We offer or coordinate the major fertility preservation options, and a navigator helps families understand their choices and move through the process. Many committed individuals at Children's National make this work possible, including specialists in oncology, urology, adolescent gynecology, reproductive endocrinology, stem cell transplant and anesthesiology.

Q: What does the future of fertility preservation care look like?
A: My goal is for fertility preservation to become an accessible, routine part of cancer care. Every patient family should be offered an informed conversation about risk and options. Stronger research, policy and clinical systems can create a smoother path to care.