Fertility preservation access remains unequal for young female cancer patients

A new Columbia University School of Nursing systematic review reveals access to fertility preservation (FP) care remains limited and unequal for girls and young women with cancer. The research article, "Fertility Preservation Access Among Female Adolescents and Young Adults with Cancer: A Systematic Review," was published in Cancer on June 23, 2026. 

Each year, more than 85,000 adolescents and young adults (AYAs), individuals aged 15 to 39 years, are diagnosed with cancer in the United States. Following diagnosis, AYAs face an increased risk of long-term treatment-related effects, including cardiotoxicity, ototoxicity, and infertility. Among these, infertility is frequently reported as the most distressing concern by girls and young women with cancer. The American Society of Clinical Oncology published guidelines on FP care on May 1, 2006, which emphasizes FP as essential to cancer care. Despite this, female patients are offered FP care at less than half the rate of male patients because available interventions are often costly, invasive, and time sensitive. 

The review of existing literature from 2006 to 2025 reveals inconsistent implementation of these guidelines, resulting in inequities across gender, race, geography, and socioeconomic status. Out of 10,151 publications that were initially identified through a standard search, the Columbia Nursing research team found 25 that focused on access to FP care among girls and young women with cancer. Notably, most of these studies documented barriers to FP care, but few found evidence of 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." 

These inequities underscore the need for routine integration of FP into oncology care and for interventions that address structural and geographic barriers, the authors conclude. 

This work was supported by the Reducing Health Disparities through Informatics (RHeaDI) Pre and Postdoctoral Training Program T32 Grant. Study authors include Marcela Algave, MPhil, Sophie Junak, MPhil, Rebecca Schnall, PhD, and Melissa Beauchemin, PhD.