Health equity in fertility specialty care among cancer survivors

For many reproductive-age cancer survivors, access to safe and effective methods for fertility preservation is an essential but often elusive path to creating a family. As more women delay childbirth and greater numbers are diagnosed before completing childbearing, fertility concerns have become increasingly relevant. Although the appropriateness of fertility treatment varies by clinical and patient factors, cancer survivors often require assisted reproductive technologies (ARTs) at younger ages and may face reduced chances of conception. Fertility-related needs arise in two key clinical contexts: at cancer diagnosis (for fertility preservation) and after treatment completion (to achieve pregnancy). In both situations, multiple factors—such as insurance coverage, geographic access to ART clinics, and neighborhood socioeconomic conditions—can affect access to services. Many patients pay out of pocket for ARTs, making this option unaffordable for those with limited financial means. Our study addresses two primary questions: 1. What are the sources and extent of variation in fertility preservation, ART use, and live births among cancer survivors? 2. Can expanded access to ARTs mitigate these variations in outcomes? Using a multilevel framework, we will examine how individual-, neighborhood-, and policy-level factors (e.g., state insurance mandates) influence ART access and use. Our specific aims are to: - Investigate factors associated with fertility preservation - Investigate factors associated with ART use after treatment - Assess how these factors contribute to live birth rates following cancer diagnosis Findings will clarify the barriers that affect family-building opportunities for reproductive-age cancer survivors and support evidence-based policy and service delivery improvements.