Factors Associated With Fertility Preservation in a Pediatric, Adolescent and Young Adult Population

Objective: To determine the patient characteristics associated with pursuing fertility preservation (FP) before gonadotoxic therapy in a pediatric, adolescent and young adult patient population. Methods: This is a retrospective cohort study of patient data at Cincinnati Children's Hospital Medical Center. Demographics, clinical diagnoses, and treatment characteristics were compared between participants that selected FP versus those that declined. Variables were analyzed separately for males and females by logistic regression. Results: Patients with a hematologic cancer were less likely to be eligible for preservation: 53.9% of ineligible males, P<0.001, and 51.8% of ineligible females, P<0.0001. Among patients who were candidates for FP, those receiving high-risk therapy were more likely to elect for FP (65.3% males, P<0.0001, and 87.5% of females, P<0.0001). Pubertal males were more likely to undergo preservation than prepubertal males (70.5% vs. 29.5%, P<0.0001; however, this trend was not demonstrated among female patients. In both males and females, race, ethnicity, religion, primary language, and insurance status were not shown to be statistically significant factors in predicting utilization of FP. Conclusion: Risk of infertility, type of cancer, and developmental status influenced decisions on pursuing FP in pediatric, adolescent and young adult patients facing iatrogenic infertility.