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Disparities in fertility preservation use among adolescent and young adult women with cancer

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Abstract

Purpose

Women face multiple barriers to fertility preservation after cancer diagnosis, but few studies have examined disparities in use of these services.

Methods

Women aged 15–39 years diagnosed with cancer during 2004–2015 were identified from the North Carolina Central Cancer Registry and linked to the Society for Assisted Reproductive Technology Clinic Outcomes Reporting System. Women who cryopreserved oocytes or embryos for fertility preservation (n = 96) were compared to women who received gonadotoxic treatment but did not use fertility preservation (n = 7964). Conditional logistic and log-binomial regression were used to estimate odds ratios (ORs) or prevalence ratios (PRs) and 95% confidence intervals (CIs).

Results

Few adolescent and young adult women with cancer in our study (1.2%) used fertility preservation. In multivariable regression, women less likely to use fertility preservation were older at diagnosis (ages 25–29 vs. 35–39: OR = 6.27, 95% CI: 3.35, 11.73); non-Hispanic Black (vs. non-Hispanic White: PR = 0.44, 95% CI: 0.24, 0.79); and parous at diagnosis (vs. nulliparous: PR = 0.24, 95% CI: 0.13, 0.45); or lived in census tracts that were non-urban (vs. urban: PR = 0.12, 95% CI: 0.04, 0.37) or of lower socioeconomic status (quintiles 1–3 vs. quintiles 4 and 5: PR = 0.39, 95% CI: 0.25, 0.61).

Conclusions

Women with cancer who were older, non-Hispanic Black, parous, or living in areas that were non-urban or of lower socioeconomic position were less likely to use fertility preservation.

Implications for Cancer Survivors

Clinical and policy interventions are needed to ensure equitable access to fertility services among women facing cancer treatment–related infertility.

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Funding

This research was supported in part by R01 CA204258 and R01 CA211093, St. Baldrick’s Foundation Scholar Award 523803, and P30 ES010126. CM was supported by the University of North Carolina Lineberger Cancer Control Education Program (T32 CA057726) and the National Cancer Institute of the National Institutes of Health (F31 CA260787).

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Authors and Affiliations

  1. Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, 135 Dauer Dr., Chapel Hill, NC, 27599, USA

    Clare Meernik, Stephanie M. Engel, Christopher D. Baggett, Nidia Rodriguez-Ormaza, Andrew F. Olshan & Hazel B. Nichols

  2. Department of Biostatistics, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA

    Ally Wardell & Jianwen Cai

  3. Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA

    Christopher D. Baggett & Parul Gupta

  4. Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, East Lansing, MI, USA

    Barbara Luke

  5. Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Valerie L. Baker

  6. Redshift Technologies, Inc., New York, NY, USA

    Ethan Wantman

  7. Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Jose Alejandro Rauh-Hain

  8. Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA

    Jennifer E. Mersereau

  9. Department of Pediatrics and the Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA

    Andrew B. Smitherman

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  1. Clare Meernik
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  2. Stephanie M. Engel
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  3. Ally Wardell
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  14. Jianwen Cai
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  15. Hazel B. Nichols
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Contributions

Clare Meernik: conceptualization, formal analysis, writing—original draft, writing—review and editing. Stephanie Engel: conceptualization, writing—review and editing. Ally Wardell: data curation, writing—review and editing. Christopher Baggett: data curation, writing—review and editing. Parul Gupta: data curation, writing—review and editing. Nidia Rodriguez-Ormaza: writing—review and editing. Barbara Luke: writing—review and editing. Valerie Baker: writing—review and editing. Ethan Wantman: writing—review and editing. Jose Alejandro Rauh-Hain: writing—review and editing. Jennifer Mersereau: writing—review and editing. Andrew Olshan: writing—review and editing. Andrew Smitherman: writing—review and editing. Jianwen Cai: writing—review and editing. Hazel Nichols: funding acquisition, conceptualization, supervision, writing—review and editing.

Corresponding author

Correspondence to Clare Meernik.

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Conflict of interest

EW: Redshift is the data vendor for SART. All other authors declare no conflicts of interest.

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Meernik, C., Engel, S.M., Wardell, A. et al. Disparities in fertility preservation use among adolescent and young adult women with cancer. J Cancer Surviv 17, 1435–1444 (2023). https://doi.org/10.1007/s11764-022-01187-y

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  • DOI: https://doi.org/10.1007/s11764-022-01187-y

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