Fertility preservation access among female adolescents and young adults with cancer: A systematic review.
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Adolescents and young adults (AYAs; aged 15-39 years) with cancer face significant threats to future fertility. Despite fertility preservation (FP) guidelines, disparities in access persist, particularly among female AYAs. This systematic review aims to describe FP access and explore disparities by sociodemographic and clinical factors among female AYAs with cancer in the United States. This systematic review was registered in PROSPERO (CRD420251077846) and conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, the Cumulative Index to Nursing and Allied Health Literature, and Embase were searched from May 1, 2006, through July 17, 2025. Eligible studies were US-based, peer-reviewed observational or interventional studies examining FP access among female AYAs with cancer. Two reviewers independently screened articles, extracted data, and appraised methodological quality with Joanna Briggs Institute tools. Among 10,151 records, 25 studies met the inclusion criteria. All included studies demonstrated high methodological quality and low risk of bias. Reported rates of FP discussions ranged from 9% to 75%, referrals or consultations with fertility specialists ranged from 0.9% to 57%, and completion of FP procedures 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. Barriers included non-Hispanic Black or Hispanic race/ethnicity, lower income, public insurance, and residence in rural or low-resource areas. Institutional interventions improved access but did not eliminate the underlying disparities. Substantial inequities in FP access persist for female AYAs with cancer in the United States, which underscores the need for routine integration of FP into oncology care and for interventions that address structural and geographic barriers.