A systematic review by Columbia University School of Nursing published on June 23 reveals that access to fertility preservation care remains limited and unequal for girls and young women with cancer. The research article, titled "Fertility Preservation Access Among Female Adolescents and Young Adults with Cancer: A Systematic Review," appeared in the journal Cancer.
Each year, more than 85,000 adolescents and young adults aged 15 to 39 are diagnosed with cancer in the United States. After diagnosis, these individuals face increased risks of long-term treatment-related effects such as cardiotoxicity, ototoxicity, and infertility. Among these concerns, infertility is frequently reported as the most distressing by girls and young women with cancer. The American Society of Clinical Oncology published guidelines on May 1, 2006, that emphasize fertility preservation as essential to cancer care. Despite this guidance, female patients are offered fertility preservation care at less than half the rate of male patients due to interventions often being costly, invasive, and time sensitive.
The review examined literature from 2006 to 2025 and found inconsistent implementation of these guidelines. This inconsistency has resulted in inequities across gender, race, geography, and socioeconomic status. Of over 10,000 publications initially identified through a standard search process, the Columbia Nursing team found only 25 focused specifically on access to fertility preservation care among girls and young women with cancer. Most studies documented barriers rather than interventions addressing them.
"Rates of FP discussions with healthcare providers ranged from 9% to 75%, consultations with fertility specialists ranged from 0.9% to 57%, and FP completion ranged from 0.56% to 70.3%. Facilitators of access included younger age, private insurance, nulliparity, higher socioeconomic status, certain cancer types, and more recent diagnosis year," the authors report.
"This review also highlights the multidimensional nature of disparities in fertility preservation care delivery and access. Consistent with prior literature, racial and ethnic minority patients were significantly less likely to receive counseling, referrals, or complete fertility preservation. Similar inequities have been documented across other domains of survivorship care, suggesting that barriers to fertility preservation reflect broader structural inequities within oncology systems," according to the study authors.
The authors conclude that these inequities underscore a need for routine integration of fertility preservation into oncology care along with interventions targeting structural and geographic barriers.
