(38) Disparities in Access to Fertility Preservation among Adolescents undergoing gonadotoxic therapies

Background: Fertility preservation (FP) counseling and interventions for adolescents prior to potentially gonadotoxic therapies is not yet accessible for all patients. Current literature acknowledges multiple known barriers to FP including insurance coverage, provider knowledge of options, and need for urgent treatment initiation. However, there is limited research surrounding disparities for accessing these services for children. This study aimed to identify inequities in receiving FP services among children undergoing gonadotoxic therapy

Methods: A retrospective chart review was performed at a single academic medical center for patients aged 0-21 years old referred to Reproductive Endocrinology for FP counseling prior to gonadotoxic therapy. Patients were excluded if they were referred after treatment, prior to gender affirming therapy, or for fertility discussion due to a genetic condition. Data collected included demographics, referring provider, type of treatment, urgency of treatment initiation, and if FP was ultimately performed. Minority patients were defined as non-white race and Hispanic ethnicity. Analysis to assess differences in receiving FP based on treatment status and minority identity status was performed using paired t-tests. IRB approval was obtained

Results: The cohort included 136 patients. The majority of patients were White (72%) and identified as non-Hispanic (96%)(Table 1). Forty-six (34%) patients had Medicaid insurance. Most patients (83%) had a cancer diagnosis. 54% (n=74) of patients had gonadotoxic treatment starting urgently. Of those, 82% (n=61) desired FP and 90% (n=55) received it. All fifty-five patients who received FP also received Lupron. For referred patients without urgent treatment needs, 86% (42/49) who desired FP ultimately received it, and 36% (15/49) underwent oocyte cryopreservation as opposed to Lupron. No patients underwent ovarian tissue cryopreservation. Minority patients desired FP at a higher rate than non-minority patients (89% vs 78%, P=.10), but were significantly less likely to receive FP when desired (76% vs 93%, P<.01). There was no difference in cost being cited as the largest barrier to care between minority and non-minority groups (58% vs 80%, P = 0.39)

Conclusions: This study identified inequities in rates of FP among adolescents undergoing gonadotoxic therapy. Minority patients were less likely than non-minority patients to be able to access FP when desired. Further research is needed to determine how to make FP services more accessible among to all patients, regardless of minority status