Discuss Fertility Preservation Research Articles

Determinants of Decision Regret Regarding Fertility Preservation in Adolescent and Young Adult Cancer Survivors: A Systematic Review.

Given recent advances in cancer therapeutics, there is a growing population of adolescent and young adult (AYA) cancer survivors navigating the physical and psychological consequences of cancer treatment. Fertility preservation (FP) conversations are of increasing importance for these survivors. Decision regret (DR) is a measure of distress or remorse following a health care decision, and it is a useful tool to evaluate the impact of a treatment on quality of life. The aim of this systematic review is to culminate existing literature focused on determinants of FP DR among AYA cancer survivors and to propose future interventions to reduce DR among AYA cancer survivors. An electronic database search was performed using PubMed, Web of Science, and APA PsycINFO for articles published before December 2023 using the following search criteria: PubMed: "Fertility Preservation"[Mesh] AND decision regret, APA PsycINFO and Web of Science: Fertility Preservation AND decision regret. Articles were organized into five categories that emerged after initial review. Nineteen articles that focused on DR and FP in AYA cancer survivors aged ≤40 and ≥12 years were included. Article results were categorized into five categories pertaining to determinants of FP DR: Unmet Informational and Emotional Needs, Need for Developmentally Appropriate Conversations, Insufficiency of Provider Training, Quality and Timeliness of Fertility Preservation Discussions, and Societal Barriers. These results highlight the need for improved patient and provider education on FP, such as future longitudinal studies focused on standardization of FP-related protocols and the impact of their implementation on DR, especially for AYA cancer survivors.

Abstract PO4-11-11: Provider perceptions of the POSITIVE trial, endocrine therapy interruption, and fertility preservation

Abstract Background: Fertility preservation and family planning are pressing survivorship concerns for many young, reproductive-aged women with hormone receptor-positive (HR+) early-stage breast cancer. Following primary treatment, patients typically receive 5-10 years of adjuvant endocrine therapy (ET), during which pregnancy is contraindicated and fertility may decrease. The first-of-its-kind POSITIVE trial (NCT02308085) sought to challenge this archetype by prospectively evaluating the impact of temporary ET interruption to allow patients to attempt conception. Participants (n=516) received 18-30 months of ET followed by a 3-month washout period prior to initiating a 2-year break from therapy to attempt pregnancy. Results demonstrated that short-term disease outcomes were not impacted by temporarily pausing therapy to allow women who desire conception to attempt pregnancy. This survey-based study aimed to evaluate community oncologists’ perceptions of the POSITIVE trial data, ET interruption, and fertility preservation efforts. Methods: US-based oncologists convened at three live meetings in March and April 2023 to review clinical updates presented at SABCS 2022. Participant characteristics and demographic data were collected via an online survey prior to the respective meetings. Perceptions/reactions to clinical updates were captured using audience response system technology. Data were summarized using descriptive statistics. Results: Among 157 respondents, 82.8% identified as community providers, with 17.9 mean years of clinical experience. On average, participants reported that 85.4% of their time is allocated towards direct patient care, with approximately 21 patients seen per clinic day. Most respondents (85.8%) indicated that they only refer patients to a fertility specialist if the patient initiates fertility preservation discussions and nearly half (45.7%) reported that within the last year, 20% or less of their patients have discussed fertility concerns with them prior to initiating therapy. Additionally, over three-quarters of respondents (79.9%) indicated that 10% or less of their patients with breast cancer underwent fertility preservation within the last year. Prior to reviewing the POSITIVE trial data, 51.3% of respondents reported that they would be most likely to offer therapy interruption to patients with low- or intermediate-risk disease, while 19.8% would do so for all patients regardless of risk status. After reviewing the POSITIVE trial data, 59.3% of respondents would offer therapy interruption to patients with low- or intermediate-risk disease, while 30% would do so for all patients regardless of risk status. Notably, a majority of respondents (54.8%) indicated that they would recommend a therapy interruption of 12 months or less, while 11.1% would opt for 19-24 months. Conclusions: Findings demonstrate that the onus of initiating discussions surrounding fertility and reproductive topics is often placed on patients, and many patients do not proactively address these matters or undergo fertility preservation prior to initiating treatment. Overall, respondents viewed the POSITIVE trial favorably, as evidenced by their increased willingness to consider temporary ET interruption for all patients following their review of the study data. Although the POSITIVE trial allowed up to 2 years of therapy interruption, respondents preferred a treatment break of 12 months or less. With the adoption of the POSITIVE strategy into routine clinical practice, younger women with HR+ breast cancer may no longer be faced with the difficult choice of pursuing potentially life-saving therapy or starting/expanding a family, thereby addressing a current unmet survivorship need among this patient population. However, it remains to be seen how many physicians will offer this approach, who is the ideal candidate, and what the appropriate ET interruption length will be. Citation Format: Brooke Leon, Robert Bone, Yolaine Jeune-Smith, Sigrun Hallmeyer, Bruce Feinberg. Provider perceptions of the POSITIVE trial, endocrine therapy interruption, and fertility preservation [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-11-11.

Fertility Preservation Knowledge and Attitudes Among Medical Students as Future Practitioners [ID 2683445

INTRODUCTION: Medical students are the next generation of physicians and provide a current snapshot of medical education. The objective of the study was to gain insight into the knowledge and attitudes regarding fertility preservation among medical students. METHODS: Medical students at The University of Kansas School of Medicine (KUSM) participated in a prospective, cross-sectional web-based survey study. Survey questions included knowledge-based questions based on the American Society for Reproductive Medicine fertility preservation guidelines, and attitudes towards fertility preservation were measured using Likert scales. This study was IRB approved. RESULTS: Most respondents (N=123; response rate: 14.1%) were aged 20–29 years (94.3%; n=116) and were pursuing family medicine (18.7%; n=23). In terms of training, 16.5% of respondents (n=20) reported having formal lectures on fertility preservation and 31.7% (n=38) on assisted reproduction technology. More than 45% of clinical students reported not being exposed to reproductive endocrinology and infertility or fertility preservation on clinical rotations (n=32/70). Only 1.6% of respondents (n=2) correctly answered at least 75% of knowledge questions about fertility preservation. Almost half (49.5%; 51/103) of respondents reported discomfort discussing fertility preservation with patients needing fertility preservation. Patient prognosis, finances, and age were the top factors influencing the professional decision to provide a patient with fertility preservation information. CONCLUSION: Students indicate poor familiarity and comfort with discussing fertility preservation, which in the future, may reduce and/or delay patient access to this option. Thus, medical student curriculum focused on reproductive endocrinology and fertility preservation represents an important educational opportunity to improve patient care and outcomes.

Fertility Preservation in the Transgender and Nonbinary Population: A Survey Study [ID 2683653

INTRODUCTION: To date, there are little data discussing fertility preservation desires of transgender and nonbinary adults. This study seeks to examine the demographic characteristics of transgender and nonbinary adults interested in or who have pursued fertility preservation as well as assess the barriers these adults face when interested in fertility preservation. METHODS: An online survey was designed by a team of researchers at an academic medical center. It was assessed for readability by an expert in survey design and reviewed for relevance by members of the transgender and nonbinary communities. It was distributed to an international audience. Participants were 18+, English-speaking, identified as non-cisgender, and had interest or previous experience in completing fertility preservation. The survey was distributed online from November 2022 to May 2023. Results were analyzed using REDCap Stats & Charts software. RESULTS: In total, 102 participants initiated the survey. Fifty-three participants met inclusion criteria for analysis. The majority of participants identified either as transgender woman (43.3%; 23) or nonbinary (32.1%; 17), with 18.9% (10) identifying as transgender man. 17 (32.1%) participants had previously preserved eggs, sperm, or embryos, and 36 (67.9%) were interested in, but had not yet pursued, fertility preservation. Of participants who had completed preservation, 94.1% (16) were assigned male at birth. Of those interested in fertility preservation, 61.8% (21) were assigned female at birth. In terms of barriers to preservation, 63.8% (23) quoted cost as a barrier, despite 91.4% (32) having insurance. CONCLUSION: This survey demonstrates that transgender and nonbinary adults are both interested in and have pursued fertility preservation. In our study sample, only transgender women had been able to complete fertility preservation, which may be illustrative of the more arduous and costly process of preserving oocytes versus sperm. Our results demonstrate, as anticipated, cost continues to be the most common barrier to fertility preservation.

Ethical, legal, social, and policy issues of ovarian tissue cryopreservation in prepubertal girls: a critical interpretive review.

Despite the increasing number of childhood cancer survivors, significant advances in ovarian tissue cryopreservation (OTC) technique and medical societies' recommendations, fertility preservation (FP) and FP discussions are not always offered as a standard of care in the pediatric context. The aim of this literature review is to understand what ethical, legal, social, and policy issues may influence the provision of FP by OTC in prepubertal girls with cancer. A critical interpretive review of peer-reviewed papers published between 2000 and January 2023 was conducted, guided by the McDougall's version of the critical interpretive synthesis (Dixon-Woods), to capture recurring concepts, principles, and arguments regarding FP by OTC for prepubertal girls. Of 931 potentially relevant papers, 162 were included in our analysis. Data were grouped into seven thematic categories: (1) risks of the procedure, (2) unique decision-making issues in pediatric oncofertility, (3) counseling, (4) cultural and cost issues, and (5) disposition of cryopreserved reproductive tissue. This first literature review focusing on ethical, legal, social, and policy issues surrounding OTC in prepubertal girls highlights concerns in the oncofertility debate. Although OTC is no longer experimental as of December 2019, these issues could limit its availability and the child's future reproductive autonomy. This review concludes that specific actions must be provided to enable the offer of FP, such as supporting families' decision-making in this unique and complex context, and providing pediatric patients universal and full access to free or highly subsidized OTC.

Increasing access to fertility preservation for women with breast cancer: protocol for a stepped-wedge cluster randomized trial in France

BackgroundWith the increase in the number of long-term survivors, interest is shifting from cancer survival to life and quality of life after cancer. These include consequences of long-term side effects of treatment, such as gonadotoxicity. Fertility preservation is becoming increasingly important in cancer management. International recommendations agree on the need to inform patients prior to treatments about the risk of fertility impairment and refer them to specialized centers to discuss fertility preservation. However, the literature reveals suboptimal access to fertility preservation on an international scale, and particularly in France, making information for patients and oncologists a potential lever for action. Our overall goal is to improve access to fertility preservation consultations for women with breast cancer through the development and evaluation of a combined intervention targeting the access and diffusion of information for these patients and brief training for oncologists.MethodsFirstly, we will improve existing information tools and create brief training content for oncologists using a qualitative, iterative, user-centred and participatory approach (objective 1). We will then use these tools in a combined intervention to conduct a stepped-wedge cluster randomized trial (objective 2) including 750 women aged 18 to 40 newly treated with chemotherapy for breast cancer at one of the 6 participating centers. As the primary outcome of the trial will be the access to fertility preservation counselling before and after using the combined intervention (brochures and brief training for oncologists), we will compare the rate of fertility preservation consultations between the usual care and intervention phases using linear regression models. Finally, we will analyse our approach using a context-sensitive implementation analysis and provide key elements for transferability to other contexts in France (objective 3).DiscussionWe expect to observe an increase in access to fertility preservation consultations as a result of the combined intervention. Particular attention will be paid to the effect of this intervention on socially disadvantaged women, who are known to be at greater risk of inappropriate treatment. The user-centred design principles and participatory approaches used to optimize the acceptability, usability and feasibility of the combined intervention will likely enhance its impact, diffusion and sustainability.Trial registrationRegistry: ClinicalTrials.gov. Trial registration number: NCT05989776. Date of registration: 7th September 2023. URL: https://classic.clinicaltrials.gov/ct2/show/NCT05989776.Protocol versionManuscript based on study protocol version 2.0, 21st may 2023.

Fertility preservation choices and decisional regret after gender-affirming surgery in transgender men or gender nonbinary persons

To investigate the prevalence of decisional regret regarding preoperative fertility preservation choices after gender-affirming surgery or removal of reproductive organs. Cross-sectional. University-based pratice. A total of 57 survey respondents identifying as transgender men or gender nonbinary with a history of gender-affirming surgery or removal of reproductive organs between 2014 and 2023 with the University of North Carolina Minimally Invasive Gynecology division. Survey or questionnaire. The prevalence and severity of decisional regret regarding preoperative fertility preservation choices were measured with the use of the validated decisional regret scale (DRS) (scored 0-100). Secondary outcomes included patient-reported barriers to pursuing reproductive endocrinology and infertility consultation and fertility preservation treatment. The survey response rate was 50.9% (57/112). "Mild" to "severe" decisional regret was reported by 38.6% (n = 22) of survey respondents, with DRS scores among all respondents ranging from 0-85. Higher median DRS scores were associated with patient-reported inadequacy of preoperative fertility counseling regarding implications of surgery on future fertility or family-building (0vs. 50) and fertility preservation options (0 vs. 12.5). No desire for future fertility at the time of fertility counseling was the most frequent reason (68.4%) for declining a referral to reproductive endocrinology and infertility for additional fertility preservation discussion. Decisional regret regarding preoperative fertility preservation choices is experienced among transgender men or gender nonbinary persons after gender-affirming surgery or the removal of reproductive organs. Preoperative, patient-centered fertility counseling and fertility preservation treatments should be provided to reduce the risk of future regret.

#205 : Pre-Orchidectomy Fertility Preservation in a Regional Queensland Centre - Patient Attitudes to Sperm Banking

Background and Aims: Fertility preservation for testicular cancer remains an essential part of the pre-operative radical orchidectomy discussion. In Australia, testicular cancer is estimated to account for 1.1% of all new male cancer diagnoses, with greater than 800 new cases a year diagnosed in Australia. Toowoomba Hospital and its urology service covers a large geographical area, extending from Toowoomba to the northern territory border. This poses both an access issue for both urological review and subsequent fertility interventions. Despite geographical barriers, pre-operative sperm banking (cryopreservation) remains generally recommended prior to operative intervention. The aim of this study was to investigate adherence to guidelines and identification of barriers or reasons for patients not wanting to engage with fertility preservation. Method: A retrospective analysis of patients undergoing a radical inguinal orchidectomy for the purposes of testicular cancer. Patient records were examined for discussion of fertility preservation and patient outcomes for attending a fertility-consultation. Results: Between 2016-2022, 54 patients underwent a radical orchidectomy at the Toowoomba Hospital. All patients pre-operatively had discussion surrounding fertility preservation and where patient accepted, referrals were made to the closest fertility provider. The majority of patients who refused pre-operative sperm banking had clear reasoning including completion of family. Conclusion: Fertility preservation discussions were part of all interactions pre-operatively where appropriate. Patient reasoning for declining preservation services were varied.

Fertility preservation in reproductive-aged female patients with colorectal cancer: a scoping review.

Colorectal cancer (CRC) incidence in adults younger than 50 years is steadily increasing in the USA, and treatment for CRC can impact future fertility. However, fertility decision-making in female patients with CRC can be complex, with fertility preservation (FP) counseling occurring inconsistently. The goal of this scoping review was to assess the literature regarding the frequency and quality of fertility preservation (FP) discussions taking place among oncology clinicians and their reproductive-age female patients with colorectal cancer (CRC) in order to identify existing gaps in care and inform future research, interventions, or potential changes in practice. A comprehensive literature search was conducted using the Ovid Medline, PsycInfo, and Scopus databases in order to identify studies pertaining to FP counseling in reproductive-age female patients with CRC. We used Covidence to screen studies for relevance and to extract data. Findings of interest included rate of fertility and/or FP discussions, patient characteristics associated with fertility discussions, initiators of discussions, rate of referrals to fertility specialists, patient utilization of FP services, and unmet fertility needs. We performed both quantitative and qualitative data synthesis. We identified five studies that met our inclusion criteria, all published between 2007 and 2022. Frequency of fertility counseling discussions was low across studies, with a range of 15 to 52.5% of female patients with CRC receiving counseling. Patient characteristics which may be associated with likelihood of fertility discussion included age, parity, number of children, cancer location and stage, treatment type, and quality of life. The literature suggested that fertility discussions were initiated by clinicians about two-thirds of the time, and medical oncologists were the clinicians most likely to initiate. Studies did capture unmet fertility-related patient needs; participants who did not receive counseling often expressed desire for these discussions and regret that they did not occur. Despite increasing incidence of CRC in patients at younger ages, this scoping review found a dearth of research conducted on young female CRC patients' experiences with fertility counseling and referrals. Notably, the existing research reveals that relatively few of these patients are receiving appropriate counseling. Additional research is needed to clarify current FP counseling practices, patient and clinician perceptions about FP, and ways to improve the quantity and quality of FP counseling in this patient population.

Attitude of BRCA1/2 mutation carriers towards fertility preservation, family planning and preimplantation genetic testing for primary prevention of breast and ovarian cancer in the next generation.

To study the attitude of BRCA1/2 mutation carriers regarding family planning, fertility preservation, and preimplantation genetic testing (PGT). A national cross-sectional study was conducted by the distribution of an anonymous questionnaire, from August 2022 to January 2023. The main outcomes measures were discussion, acceptance, and performance rates of fertility preservation and PGT. The questionnaire was completed by 530 BRCA1/2 mutation carriers. The mean (SD) age at mutation detection was 36.4 (9.6) years. At the time of mutation detection, 40% did not have children. Following mutation detection, 37% of responders changed their family planning, mostly choosing to have children earlier or to have less children than planned. Twenty-eight percent of BRCA carriers discussed the option of fertility preservation with a physician, 72% agreed that fertility preservation is an acceptable option for BRCA1/2 mutation carriers and finally 11% underwent oocyte/embryo vitrification before RRBSO. 44% of BRCA carriers discussed the option of PGT, 58% agreed that PGT is justified in BRCA1/2 mutation carriers and finally 8% underwent PGT to select non-carrier embryos. In a multivariate analysis, age under 35 years and the a priori need for fertility treatments were both found significant factors increasing the likelihood of performing fertility preservation and PGT. This study emphasizes that despite a substantial proportion of women admitting that mutation detection affected their family planning and high acceptance rates, performance of fertility preservation and PGT remained exceedingly low. Increasing the knowledge and awareness of these issues is important and should be included in multidisciplinary counselling.

Reproduction in life and death: should cancer patients with a poor prognosis be offered fertility preservation interventions?

In the context of a cancer diagnosis, fertility preservation interventions are used to mitigate the potential impact of gonadotoxic cancer treatment upon fertility. They provide patients with cancer the option to freeze their reproductive material to have their own biological child following treatment. The evidence suggests some clinicians are less likely to have fertility preservation discussions with patients who have an aggressive or metastatic cancer which has a poor prognosis. Although this is contrary to current policy recommendations, there is a lack of guidance relating to offering fertility preservation in the context of a poor prognosis to support clinicians. Controversy surrounds posthumous reproduction, and whether the wishes of the cancer patient, when living and deceased should take precedence over others' wellbeing. We consider the question of whether cancer patients with a poor prognosis should be offered FP from an ethics perspective. We structure the paper around key arguments to which multiple ethical principles might pertain, first establishing a central argument in favour of offering fertility preservation based on respect for autonomy, before exploring counterarguments. We conclude by proposing that a defeasible assumption should be adopted in favour of offering fertility preservation to all cancer patients who might benefit from it. It is important to recognise that patients could benefit from fertility preservation in many ways, and these are not limited to having a parenting experience. The burden of proof rests on the clinician in collaboration with their multi-disciplinary team, to show that there are good grounds for withholding the offer.

Are There Any Developments in the Attitudes and Practices of Oncologists Regarding Fertility Preservation in Saudi Arabia After 12 Years?

The current practice of offering fertility preservation (FP) counseling and treatment has become one of the focal points in patient care throughout cancer treatment. The turning point was the approval of the Council of Senior Religious Scholars four years ago to freeze tissues from the ovarian membrane, the entire ovary, and the eggs for later use in reproduction to preserve the offspring. Thus, we aimed to assess any development in oncologists' knowledge, attitude, and referral practices regarding FP in Saudi Arabia. This is a cross-sectional survey using a self-administered questionnaire. We assessed oncologists' opinions on the importance of FP, their perception of the patient's preferences, and factors to consider when discussing the subject. Then, we assessed the knowledge and referral practices, including the timing of referral before starting cancer treatment. Most oncologists showed good knowledge and positive attitudes toward FP; however, their referral practices could be better. Most were familiar with FP options. The most significant factors influencing the oncologist-patient FP discussion were the number of existing children, marital status, cost, and type of cancer (96.6%, 76.7%, 65.7%, and 58.9%, respectively). There is a significant improvement in the knowledge and attitude of oncologists toward FP. However, patients' counseling and referral to fertility services still need to be improved. There is a shortfall in the clinical practice guidelines for FP in cancer patients in Saudi Arabia. The implementation of clinical practice guidelines would enhance FP. However, patients' counseling and referral to fertility services still need to be improved. The lack of proper guidelines on FP is affecting oncologists' practice.

Body image disturbances in adolescent and young adult cancer patients confronting infertility risk and fertility preservation decisions

Purpose Body image is a major psychosocial concern for all cancer patients but can affect the adolescent and young adult (AYA) population in distinct ways. Similarly, the prospect of infertility and the fertility preservation process can create additional stress during cancer treatment. Discussions regarding infertility inherently implicate the body and its reproductive function, but downstream effects on self-perception have not been previously described. The aim of this study was to explore the experiences of AYAs as they considered their risk of infertility and options for fertility preservation (FP), specifically the ways in which this impacted body image and FP decision-making. Methods AYA cancer patients (n = 27) aged 12–25 years whose cancer and treatment conferred risk of infertility were recruited through electronic health record query at an NCI-Designated Comprehensive Cancer Center. Participants completed semi-structured interviews, which were recorded, transcribed, and deductively coded for themes related to information needs, knowledge of treatment effects on fertility, and reproductive concerns after cancer. Emergent, inductive themes related to body image were identified. Results Body image concerns, related to both physical appearance and body functioning emerged. Common concerns included anticipating change as it pertains to the body and its functions, physical discomfort, fear of judgment, and meeting expectations of the body. While these themes are broad in nature, they have been previously explored in relation to body image in general and their emergence in the oncofertility space provides guidance for further optimization of infertility and fertility preservation discussions. Conclusions AYA cancer patients experience a multitude of body image related disturbances when faced with the possibility of infertility and fertility preservation. In identifying and exploring these themes, future opportunities for improving oncofertility practice and discussions among AYAs with a focus on body image positivity are called upon.

Survey of young women with breast cancer to identify rates of fertility preservation (FP) discussion and barriers to FP care.

To identify the proportion of reproductive age women with breast cancer that engaged in a fertility preservation discussion and reproductive endocrinology and infertility (REI) consultation. This cross-sectional survey recruited women 18-42 years who were diagnosed with breast cancer from 2006 to 2016 by phone or email and asked them to complete an online survey. Demographic characteristics, barriers to FP, utilization of FP consultation, and FP procedures (oocyte and embryo cryopreservation) were analyzed. A majority of women (64%) did not have FP discussed by any provider. Older women and those who were parents at the time of diagnosis were less likely to engage in a FP discussion. However, there were no significant differences in partner status or cancer stage between women with or without FP discussions. Of the women who desired future children prior to the cancer diagnosis, 93% received chemotherapy; however, only 34% of these women had a consultation with an REI. The most common reasons for declining FP consultation were already having their desired number of children (41%), financial barriers (14%), and concern about delaying cancer treatment and cancer recurrence (12%). Forty percent of women who desired future children and met with an REI pursued FP procedures. Younger women were more likely to receive FP counseling. FP consultations and procedures were low even in women who desired future fertility, with the predominant barriers being cost, fears concerning a delay in cancer treatment, and future cancer recurrence.

Disparities in fertility preservation in rural adolescent and young adult patients with hematologic malignancies.

e18764 Background: As survival of patients with hematologic malignancies improves, quality of life (QOL) measures have gained importance. Cancer therapies can have a deleterious impact on fertility in patients of childbearing age. Previous studies have highlighted disparities in access to oncology care in rural patients, with negative effects on health outcomes and QOL. This study aims to explore the impact of rurality on fertility preservation in adult young adult (AYA) population. Methods: The study examined patients with a new diagnosis of acute leukemia or lymphoma, ages 15-39, between 2017-2022 at the University of Vermont Medical Center. These included Acute lymphoblastic leukemia (ALL), Acute myeloid leukemia (AML), Hodgkin’s lymphoma, and Non-Hodgkin’s lymphoma. We identified 145 patients and collected data on demographics, insurance, zip codes, cancer diagnoses and whether referral to fertility preservation was requested. Rurality was determined using United States census data, with Rural-Urban Commuting Area (RUCA) codes 1-3 considered urban, and codes 4-10 being considered rural. Results: Of the 145 patients, majority resided in rural (N = 81 or 56%) as compared to urban areas (N = 64 or 44%). Majority of patient did not receive a referral for discussion of fertility preservation (N = 77 or 53%). Of the patients that were referred, more urban patients received referrals (N = 38 or 56%), compared to rural cancer patients (N = 30 or 44%), and this difference was statistically significant (OR = 2.5, 95% CI 1.2-5.14, p = 0.0074). The type of insurance the patient had impacted referral rates. Patients with private insurances were more likely to receive a referral compared to those who had no insurance or had Medicare/Medicaid, (N = 41 or 60% vs. N = 27 or 40%) and this difference was also statistically significant (OR = 2.13, 95% CI 1.04-4.38, p = 0.0243). Conclusions: We find that rural AYA patients with hematologic malignancies were less likely to receive referral for fertility preservation, compared to their urban counterparts. Patients with private insurances had the highest rates of referrals, while patients with Medicare/Medicaid or no insurance were less likely to be referred. This study highlights disparities in access to fertility preservation in rural cancer patients, with significant potential impact on quality of life.

The utilization of cryopreserved sperm in males with cancer.

e18791 Background: Ten percent of individuals diagnosed with cancer in the United States are under age 45. Fortunately, improvements in cancer therapy have enabled younger individuals to survive with cancer related deaths decreasing steadily over the past 20 years. The American Society for Clinical Oncology (ASCO) recognizes the importance of future family building for cancer survivors and states healthcare providers should discuss fertility preservation options prior to cancer treatment initiation. Despite these recommendations, the data regarding survivor utilization of cryopreservation sperm is limited. The aim of this study is to assess factors that impact the post treatment utilization of cryopreserved sperm. Methods: 721 patients who underwent sperm cryopreservation for cancer indication from 1/1/2010 – 10/1/2020 at a single institution were included in the retrospective chart analysis. Cancer diagnosis, patient age at time of sperm banking, sample storage duration, and sample disposition were collected. Sample disposition included utilization for pregnancy effort(s), request to discard and/or donate to research, and lost to follow up. Descriptive statistics were employed via Excel. Results: Fifty-two of 721 (7.21%, 95% CI 5.4-9.4%) patients utilized their sperm samples for fertility treatment, and 104 patients (14.42%) subsequently requested their samples be discarded. When stratified by age at time of sperm banking, men who banked between the ages of 36 and 40 years had the highest rate of sample utilization for pursuing fertility treatment (12/68, 17.65%, 95% CI 9.5-28.8%). Importantly, those that cryopreserved sperm and subsequently discarded the samples ranged from 8.97% (21 to 25 years) to 28.13% (41 to 45 years). When analyzed by diagnosis, patients who utilized their samples for fertility treatment had varying cancer diagnoses with percent utilization ranging from 4.11% (skin/connective tissue/musculoskeletal cancers) and 20.0% (lung cancer). Overall, 75.59% of the samples collected are unutilized (545/721, 95% CI of 72.3-78.7%). Only 3% were lost to follow up, defined as inability to contact patient after three attempts. Conclusions: Cryopreserved sperm is widely underutilized with only 7.21% of patients utilizing the samples for future conception. Men between ages 36 to 40 years at time of banking are most likely to utilize their samples and utilization varied by cancer diagnosis. This large cohort (with less than 5% lost to follow up) highlights the importance in identifying additional predictors of cryopreserved sperm utilization in cancer survivors. [Table: see text]

(045) The Importance of Fertility Preservation in the Transgender Population

Abstract Introduction The transgender population has long been marginalized by society. Societal stigmata, fear to seek care, and dearth of provider knowledge regarding transgender health issues has caused disparities to widen. Objective The purpose of this case study is to call to attention the often-overlooked aspect of pediatric transgender care: the importance of fertility preservation prior to instituting gender-affirming therapy. Methods Twenty-one genetically XY females, followed by their multidisciplinary transgender care teams, were interested in starting hormone therapy due to impending onset and/or progression of puberty. Fortunately for these patients, their physicians were aware of fertility struggles after undergoing hormone therapy. Results Sperm cryopreservation via open gonadal biopsy, testicular tissue cryopreservation (TTC), and semen sample (when age/maturity-appropriate) were discussed. Though requiring surgery, biopsy/TTC relieves patients of the psychological impact of semen sample production. With IRB approval, 20 patients (median age 12 years, range 10-16 years) underwent TTC (Figure 1). One patient (age 16 years) opted for semen sample. All patients had success with spermatogonial stem cells cryopreserved for future patient use. Conclusions Gender affirming procedures and hormone therapy affect the long-term reproductive potential of transgender individuals. While cost concerns and insurance coverage regarding oncofertility is a prominent area of discussion, the transgender community is often excluded. With more individuals beginning medical and surgical therapy at a younger age, fertility preservation discussions are essential but often overlooked, depriving these individuals the joy of becoming a biological parent. As health care providers, addressing psychological, emotional, physical, and spiritual needs of patients is crucial, and fertility is a key aspect of this care. TTC can be safely done in pediatric populations, though research is necessary to expand beyond current experimental stage of tissue-development. Disclosure No

(275) Health Care Disparities in the Transgender Population

Abstract Introduction The transgender population has largely been marginalized by society, causing inequities in health care delivery. The dearth of provider knowledge on transgender health issues further exacerbates these disparities. Objective A survey of the transgender population was conducted to help call attention to the often-overlooked aspect of care: fertility preservation prior to hormone therapy or gender affirmation surgery. Methods A survey of 65 transgender individuals was conducted, with participants recruited through Reddit transgender groups and local transgender associations, to assess their knowledge regarding fertility preservation and their experience with healthcare providers. Results were compiled and analysis was performed. Results Out of the 65 individuals who responded to the survey, approximately 88% were between the ages of 18 and 39. Seventy-four percent were assigned male gender at birth and 26% female. Sixty-two percent of individuals identified as female, 20% as male, and 18% as gender non-conforming. Only 35% of individuals had ever been cared for in a multidisciplinary transgender clinic. Interestingly, while 100% of surveyed individuals were aware that fertility would be irreversibly lost after hormonal or surgical affirmation surgery and 43% believed this to be an important issue, only 46% had any health care providers discuss fertility preservation options with them. Conclusions Hormonal therapy and gender affirming procedures affect the long-term reproductive potential of transgender individuals. While oncofertility is a prominent area of discussion, transgender care is still lagging. With an increase in medical and surgical therapy in younger individuals, health care providers must discuss fertility preservation options prior to affirmation therapy. Disclosure No

Narratives of relationality and time in fertility preservation vlogs

ABSTRACT Fertility preservation incorporates relational and temporal dynamics that have both experimental and conservative dimensions in people’s thinking about their reproductive futures, parenthood, and family building. In this article, we discuss video blog (vlog) narratives of people who have publicly documented their experience of preserving their gametes (eggs or sperm). The aim of the study is to examine how people, who are experiencing the prospect of fertility decline or disruption, frame their decision-making about gamete preservation and what this means for their future family building. As such, we organise the data around three demographic groups according to health, career and relationship status, and gender transition. To analyse the vlogs we use composite narratives, a method whereby researchers synthesise data to construct stories based on people’s lived experiences, without attributing events or details to particular people. Using this method, we draw on two conceptual tools from the sociology of personal life; relationality and temporal scripts, to highlight how vloggers discuss fertility preservation in relation to time and their experiences to real and imagined others, in making decisions about their reproductive futures.

MP43-09 THE IMPORTANCE OF FERTILITY PRESERVATION IN THE TRANSGENDER POPULATION

You have accessJournal of UrologyCME1 Apr 2023MP43-09 THE IMPORTANCE OF FERTILITY PRESERVATION IN THE TRANSGENDER POPULATION Niki Parikh, MN Rochester, Glenn Cannon, Asma Chattha, Patricio Gargollo, Kyle Orwig, Brooke McClendon, David Walker, and Candace Granberg Niki ParikhNiki Parikh More articles by this author , MN RochesterMN Rochester More articles by this author , Glenn CannonGlenn Cannon More articles by this author , Asma ChatthaAsma Chattha More articles by this author , Patricio GargolloPatricio Gargollo More articles by this author , Kyle OrwigKyle Orwig More articles by this author , Brooke McClendonBrooke McClendon More articles by this author , David WalkerDavid Walker More articles by this author , and Candace GranbergCandace Granberg More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003289.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The transgender population has long been marginalized by society. Societal stigmata, fear to seek care, and dearth of provider knowledge regarding transgender health issues has caused disparities to widen. The purpose of this case study is to call to attention the often-overlooked aspect of pediatric transgender care: the importance of fertility preservation prior to instituting gender-affirming therapy. METHODS: Twenty-one genetically XY females, followed by their multidisciplinary transgender care teams, were interested in starting hormone therapy due to impending onset and/or progression of puberty. Fortunately for these patients, their physicians were aware of fertility struggles after undergoing hormone therapy. RESULTS: Sperm cryopreservation via open gonadal biopsy, testicular tissue cryopreservation (TTC), and semen sample (when age/maturity-appropriate) were discussed. Though requiring surgery, biopsy/TTC relieves patients of the psychological impact of semen sample production. Under IRB approval, 20 patients (median age 12 years, range 10-16 years) underwent TTC (Figure 1). One patient (age 16 years) opted for semen sample. All patients had success with spermatogonial stem cells cryopreserved for future patient use. CONCLUSIONS: Gender affirming procedures and hormone therapy affect the long-term reproductive potential of transgender individuals. While cost concerns and insurance coverage regarding oncofertility is a prominent area of discussion, the transgender community is often excluded. With more individuals beginning medical and surgical therapy at a younger age, fertility preservation discussions are essential but often overlooked, depriving these individuals the joy of becoming a biological parent. As health care providers, addressing psychological, emotional, physical, and spiritual needs of patients is crucial, and fertility is a key aspect of this care. TTC can be safely done in pediatric populations, though research is necessary to expand beyond current experimental stage of tissue-development. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e604 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Niki Parikh More articles by this author MN Rochester More articles by this author Glenn Cannon More articles by this author Asma Chattha More articles by this author Patricio Gargollo More articles by this author Kyle Orwig More articles by this author Brooke McClendon More articles by this author David Walker More articles by this author Candace Granberg More articles by this author Expand All Advertisement PDF downloadLoading ...