Barriers to offering female fertility preservation to pediatric and young adult oncology patients: A national survey of pediatric hematology oncology providers in the United States and Canada.

person Amanda Walker Rutgers New Jersey Medical School, Newark, NJ info_outline Amanda Walker, Elan Baskir, Geoffrey Matthes, Sri Ram Pentakota, Teena Bhatla, Surabhi Batra

Authors person Amanda Walker Rutgers New Jersey Medical School, Newark, NJ info_outline Amanda Walker, Elan Baskir, Geoffrey Matthes, Sri Ram Pentakota, Teena Bhatla, Surabhi Batra Organizations Rutgers New Jersey Medical School, Newark, NJ, Children's Hospital of New Jersey at Newark Beth Israel Medical Center, Newark, NJ Abstract Disclosures Research Funding No funding received None. Background: The American Society of Clinical Oncology (ASCO) recently updated its guidelines on fertility preservation based on similar rates of pregnancy from oocyte and embryo preservation. However, fertility preservation in female pediatric and young adults undergoing cancer treatment remains a challenge due to barriers in communication, lack of awareness and resources. Methods: A survey created using SurveyMonkey was sent electronically to all physicians who were Children’s Oncology Group (COG) members (2190), weekly for 4 weeks. Results: 304 physicians (13.8%) responded to the survey. While most providers discuss the possibility of infertility with all female patients (83%), only 43% offer fertility preservation irrespective of age. Cancer diagnosis is a key factor in the decision to offer fertility preservation to patients (63%). Ewing sarcoma (75%), osteosarcoma (69%), and bone marrow transplant candidacy (70%) are the most common diagnoses associated with physician offering of fertility preservation. It is typically offered prior to the first round of chemotherapy (53%). Seventy-five percent of providers report that insufficient time before starting chemotherapy is a major barrier to offering fertility preservation. Severity of patient illness (58%), insurance issues and high cost (19%), provider belief that it is not necessary in every patient (25%), and lack of data supporting female fertility preservation and experimental methods (16%) are other barriers which impact the decision to offer fertility preservation. Ovarian suppression (77%), cryopreservation (egg freezing) (85%), and ovarian tissue freezing (66%) are the most discussed fertility preservation options with only one out of four providers discussing freezing embryos. Only one out of five providers check Anti-Mullerian hormone (AMH) levels prior to starting cancer treatment; however, two out of five check AMH levels after completion of therapy. Most providers do not check AMH levels. Conclusions: Despite high risk for infertility among female cancer patients due to treatment and several advances that have been made in the field, the practice of offering fertility preservation is not universal due to various barriers at the physician and institutional level. Physician education and familiarity with ASCO’s newer guidelines is one way to promote a healthier dialogue and informed decision making. We also conclude that detailed guidelines and monitoring practices for diminished ovarian reserve are lacking and need further thought. Barrier N (%) Insufficient time prior to chemotherapy 211 (76) Patients are too sick 162 (58) Not necessary in every patient 94 (34) Insurance issues 53 (19) Not enough supporting data 45 (15) Poor access 35 (13) None 26 (9) Culture/religion 8 (3) Hesitancy to discuss 6 (2)