August 2023

OBGYN

NEW RESEARCH SHOWS LIMITED ACCESS TO FERTILITY PRESERVATION FOR CANCER PATIENTS

Featuring: Kara N. Goldman, MD

In the United States, more than 3.6 million reproductive-age women lack geographic access to an oncofertility center

Certain cancer treatments, like chemotherapy and radiation therapy, can negatively impact a patient’s ability to have children. In the United States, nearly 6% of women will develop invasive cancer by the age of 50, and female cancer survivors are approximately 50% more likely to develop clinical infertility compared with noncancer survivors. Preserving fertility before the start of cancer treatment is an urgent and essential part of cancer care. However, geographic proximity to an oncofertility center is an obstacle for many patients.

Research published in JAMA Oncology in August 2023 shows that more than 3.6 million reproductive-age females lack geographic access to oncofertility services.
 
The researchers conducted a geospatial analysis that identified regions of the U.S. with disproportionately low geographic access. The states where nearly 100% of reproductive-age women have geographic access to an oncofertility center have:
  • Fertility preservation insurance mandates
  • Legislation making urgent egg and embryo freezing more affordable and accessible
 
This study highlights stark disparities between states like Illinois, where at-risk individuals have nearly ubiquitous geographic access to care and extensive insurance mandates, and neighboring states like Missouri, Indiana and Wisconsin, where at-risk patients struggle with limited geographic access, no insurance mandate or both.

“Fertility preservation is a critical part of comprehensive cancer care, but procedures like egg and embryo freezing are time-intensive, expensive and highly specialized,” says Kara Goldman, MD, corresponding author of the study, and medical director of Fertility Preservation at Northwestern Medicine Center for Fertility and Reproductive Medicine. “Given the urgent nature of fertility preservation in the face of cancer, it is critically important that patients have both geographic and financial access to this care.”

​Study Overview and Results
From 2021 to 2022, researchers analyzed locations of all fertility clinics identified through the 2018 CDC Fertility Clinic Success Rates Report, along with data from the 2020 U.S. Census. They identified the primary at-risk population as reproductive-aged women between 15 to 44 years old.
 
The researched looked at those who lived within a two-hour travel-time radius of clinics that offer fertility preservation services, and they evaluated how this intersects with the state-based insurance mandates for fertility preservation coverage.
  • Among the 456 fertility clinics, 86 (19%) didn’t meet the criteria as an oncofertility center. Oncofertility centers were defined by meeting four criteria:
    • Offered oocyte and embryo cryopreservation
    • Performed at least one fertility preservation cycle in 2018
    • Served people without partners
    • Had an accredited embryology laboratory per CDC guidelines.
  • 3.63 million (6%) of reproductive-age women lack geographic access to an oncofertility center.
  • 99% of female patients who live in a state with fertility preservation mandates live within two hours of an oncofertility center.
    • Those states are California, Colorado, Connecticut, Delaware, Illinois, Maryland, New Hampshire, New Jersey, New York, Rhode Island and Utah.
  • States without active or pending legislation for fertility preservation mandates have the lowest rates (80%) of eligible female patients with geographic access.
  • Researchers found entire regions of the country with little to no access to fertility preservation, including the Mountain West and West North Central regions, followed by the Southwest and West Virginia.
    • States with the lowest percentages include Montana (24%), Wyoming (32%) and North Dakota (49%).

“By integrating geographic and legal considerations into our analysis, we were able to identify regions of the country that are currently underserved,” says Nivedita Potapragada, co-first author of the study and a medical student at Northwestern University Feinberg School of Medicine. “Our analysis highlights the importance of addressing these geographic disparities, especially with the demand for oncofertility services continuing to grow."
​
To hear Dr. Goldman discuss the study, listen to the JAMA Oncology podcast. 
Kara N. Goldman, MD, associate professor of Reproductive Endo and Infertility in the Department of Obstetrics and Gynecology.

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