Fertility preservation and financial hardship among adolescent and young adult women with cancer
Menée aux Etats-Unis par enquête auprès de 556 adolescentes et jeunes femmes atteintes d'un cancer (âge médian au diagnostic : 33 ans), cette étude analyse leur recours à des techniques de préservation de la fertilité et les difficultés financières associées
Background: Financial hardship among adolescents and young adults (AYAs) with cancer who receive gonadotoxic treatments may be exacerbated by the use of fertility services. This study examined whether AYA women with cancer who used fertility preservation had increased financial hardship. Methods: AYA women with cancer in North Carolina and California completed a survey in 2018-2019. Cancer-related financial hardship was compared between women who cryopreserved oocytes or embryos for fertility preservation after cancer diagnosis (n=65) and women who received gonadotoxic treatment and reported discussing fertility with their provider, but did not use fertility preservation (n=491). Multivariable log-binomial regression was used to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs). Results: Women were a median age of 33 years at diagnosis and 7 years from diagnosis at the time of survey. Women who used fertility preservation were primarily aged 25-34 years at diagnosis (65%), non-Hispanic White (72%), and had at least a Bachelor's degree (85%). In adjusted analysis, use of fertility preservation was associated with 1.50 times the prevalence of material financial hardship (95% CI: 1.08, 2.09). The magnitude of hardship was also substantially higher among women who used fertility preservation: 12% reported debt of {greater than or equal to}$25,000 vs. 5% in the referent group. Conclusions: This study provides new evidence that cryopreserving oocytes or embryos after cancer diagnosis for future family-building is associated with increased financial vulnerability. Impact: More legislation that mandates insurance coverage to mitigate hardships stemming from iatrogenic infertility could improve access to fertility preservation for young women with cancer.