Formal Fertility Preservation Program Facilitates Equitable Fertility Care Among Pediatric Oncology and Stem Cell Transplant Patients

Abstract

Background: Clinical guidelines recommend discussing infertility risk and referral to fertility preservation (FP) specialists in all patients facing cancer treatment, including children. We sought to determine whether sociodemographic or clinical factors led to differences in referral and utilization of FP services at a children's hospital with a formal FP program. We hypothesized that sociodemographic differences would exist in FP utilization, but not in referral rates.

Methods: We abstracted sociodemographic and clinical details on patients receiving gonadotoxic treatment at a large urban children's hospital. Primary outcome was referral for FP consultation or documentation of fertility-related discussion. Secondary outcome was FP completion when Pediatric Initiative Network Risk Stratification System (PINRSS) risk of infertility was significant or high. Outcomes were compared using descriptive statistics, and a Poisson regression with robust variance analysis used to determine adjusted risks of outcomes.

Results: 66 % (114/172) of the total cohort and all (80/80) significant- and high-risk patients had an FP consult or documentation of fertility discussion. On adjusted analysis, only minimal risk by PINRSS was associated with a lower probability of fertility-related discussion or consult and no variables independently predicted FP completion. Sociodemographic parity existed in both outcomes.

Conclusions: The FP program supported our multi-disciplinary efforts for FP consults; when treatment-related increased risk of infertility was significant or high, a risk-related discussion/consult always occurred. Fertility discussions were less likely when infertility risks were minimal. FP consults and risk-related discussions were distributed equitably, and no sociodemographic differences were observed between those who did and did not pursue FP.

Keywords: Disparities; Fertility preservation; Gonadotoxic therapy; Oncofertility.