What should younger individuals diagnosed with myeloma know about preserving fertility before starting treatment?

What should younger individuals diagnosed with myeloma know about preserving fertility before starting treatment? This is so important. We like our patients to not only enjoy the remission, but also being able to return to what normal is like. So majority of our treatments in fact don't significantly decrease the future chance of having children except for the high dose myelofilane in stem cell transplant. So young patients who are just having a discussion about high dose myelofilane and transplant with their treating physician should probably look into the possibility of collecting this term for banking or egg for banking. Now this is for future, but for right now, unfortunately a lot of our treatments continue to have concurrent risk to the fetus. And that means increased chance of genetic abnormalities. We don't want to ever repeat the history of thalidomide class drug causing fetal defect. So I'm encouraging all of our myeloma patients to consider adequate contraception, not to expose the partner to chemotherapy unnecessarily, but also as they have a conversation with their treating physician going forward. Bring this up to the forefront. A lot of us are used to treating older individuals. Myeloma is a disease of older adults most of the time with the median age at the time of diagnosis that's really about 64, 65. But we definitely, definitely don't want to lose an opportunity of preserving the fertility in younger patients, particularly those who are younger than 40 and 50. And there are quite all kinds of resources out there now that we can tap into. So if it's not mentioned, please share your concern with your treating physician and we're here to help. Your patients, especially the younger ones, may be really interested because I think for your female young patients, it's a really big deal. Like they're too afraid to talk about, you know, difficulty with sex, vaginal dryness, like all these things that are like complex conversations for young women to have, especially with their cancer doctor who is like generally useless about these things. That like if you had like an OBGYN who was into cancer, that they would be the perfect person to talk about both, you know, pre-transplant, post-transplant, fertility preservation, and then like, you know, who should go on hormonal replacement therapy, what the risks of that are, how it will help your bone density as a myeloma patient. Like there's a whole like aspect to this that I think we don't talk about enough for patients. Generally speaking, depending on where you are, the starting point should be the doctor that's treating you for your myeloma. They'll have the best insight as to, you know, who is going to be local to you, helpful. They'll probably have somebody who's their go-to person in terms of fertility preservation, and they'll also be able to help you navigate any costs or insurance barriers that may or may not be associated with that. So that's the first person your go-to is always your treating doctor. And then don't be shy to push for these things. If it's most likely it's going to be something that's really important to you, and maybe you'll find yourself overwhelmed in the setting of a new cancer diagnosis. But this is something, these are important questions for you in the longer term that you're going to want to make sure you ask upfront.