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. 2024 Dec;41(12):3559-3565.
doi: 10.1007/s10815-024-03253-z. Epub 2024 Sep 26.

Disparities in access to fertility preservation among adolescents undergoing gonadotoxic therapies

Hana G Murphy  1 , Erin Isaacson  1 , Molly B Moravek  2 , Erin Ellman  2 , Sarah D Compton  1 , Monica W Rosen  3
Affiliations

Disparities in access to fertility preservation among adolescents undergoing gonadotoxic therapies

Hana G Murphy et al. J Assist Reprod Genet. 2024 Dec.

Abstract

Purpose: Fertility preservation (FP) for adolescents prior to potentially gonadotoxic therapies is not accessible for all patients. Current literature acknowledges multiple barriers to FP, but research surrounding disparities for accessing these services is limited. We aimed to identify inequities in receiving FP services among adolescents undergoing gonadotoxic therapy.

Methods: A retrospective chart review was performed at a single academic medical center for patients aged 0-21 referred for FP counseling prior to gonadotoxic therapy. Exclusions included referral after treatment, prior to gender-affirming therapy, or for fertility discussion due to a genetic condition. Minority patients were defined as non-White race and/or Hispanic ethnicity. Non-minority patients were defined as White, non-Hispanic. Analyses to assess differences in receiving FP based on minority identity and insurance status were performed via logistic regression, with receiving desired care as the outcome variable.

Results: Our cohort included 136 patients-38 minority and 98 non-minority. Forty-six (33.8%) patients had Medicaid, which did not differ between minority and non-minority (42.1% vs. 38.8%, P = .73). Most patients (83.1%) had a cancer diagnosis. Similar proportions of minority and non-minority patients had gonadotoxic treatment starting urgently (52.6% vs. 55.1%, P = .80), while more minority than non-minority patients desired FP (89.5% vs .77.5%, P = .10). When controlling for insurance type and age, minority participants were 12.8% less likely to receive desired FP (marginal effect = - .128, P = .05).

Conclusions: This study identified significant inequities for minority populations in accessing FP. Further research is needed to determine how to make FP services more accessible to all patients, regardless of minority status.

Keywords: Childhood cancer; Cryopreservation; Fertility preservation; Health disparities.

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Conflict of interest statement

Declarations. Ethics approval: This study was approved by the Institutional Review Board at University of Michigan and was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki. Consent to participate: Informed consent was waived by the University of Michigan Institutional Review Board, as this study was a retrospective review of existing data from standard patient care available in the electronic medical record. Competing interests: The authors declare no competing interests.

References

    1. Arnon J, Meirow D, Lewis-Roness H, Ornoy A. Genetic and teratogenic effects of cancer treatments on gametes and embryos. Hum Reprod Update. 2001;7(4):394–403. 10.1093/humupd/7.4.394. - PubMed
    1. American Cancer Society. Key statistics for cancers in adolescents. https://www.cancer.org/cancer/types/cancer-in-adolescents/key-statistics.... Accessed March 22, 2024.
    1. Miller KD, Fidler-Benaoudia M, Keegan TH, Hipp HS, Jemal A, Siegel RL. Cancer statistics for adolescents and young adults, 2020. CA Cancer J Clin. 2020;70(6):443–59. 10.3322/caac.21637. - PubMed
    1. Meirow D, Nugent D. The effects of radiotherapy and chemotherapy on female reproduction. Hum Reprod Update. 2001;7(6):535–43. 10.1093/humupd/7.6.535. - PubMed
    1. Chemaitilly W, Cohen LE. Diagnosis of endocrine disease: endocrine late-effects of childhood cancer and its treatments. Eur J Endocrinol. 2017;176(4):R183–203. 10.1530/EJE-17-0054. - PubMed

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