Key takeaways:

• Most young women with cancer do not receive fertility preservation counseling or procedures.
• Fertility preservation visits have increased substantially since 2015.

More than 95% of young women with cancer do not receive fertility preservation support, though rates increased substantially over the past decade, according to data presented at ASCO Quality Care Symposium.

An investigation of more than 275,000 women aged 40 years and younger showed fertility preservation visits increased more than six-fold between 2015 and 2025.

Data derived from Korsberg A, et al. Abstract 252. Presented at: ASCO Quality Care Symposium; Oct. 16-17, 2026; Boston.

“It’s low utilization,” Erika L. Moen, PhD, MS, associate professor of biomedical data science in the Geisel School of Medicine at Dartmouth College, told Healio. “It’s important that women are aware of the availability of these services.”

‘Public health problem’

Healio previously reported cancer incidence among individuals aged 49 years or younger increased for 14 common malignancies between 2010 and 2019, the largest absolute increases observed in breast, colorectal, kidney, uterine and pancreatic cancers.

Another study showed colorectal cancer incidence among people aged 20 to 49 years increased 3% annually between 2013 and 2022. A third investigation showed a global 3% increase in early-onset cancer among individuals aged 15 to 49 years.

These cancer trends parallel another — women having children at older ages. A federal report showed the number of births in the U.S. coming from women aged 35 years and older increased from 9% in 1990 to 21% in 2023.

Healio previously reported on multiple studies showing roughly half of adolescents and young women with breast cancer have fertility concerns.

A systematic review showed fertility preservation discussion rates with women with cancer ranged from 9% to 75%, and factors associated with these conversations included patients’ desire to have children, more education, younger age at diagnosis, nulliparity, and having gynecologic or hematologic malignancies.

ASCO updated its guidelines in 2025 recommending clinicians discuss fertility preservation both at diagnosis and throughout survivorship with patients.

“These two coinciding trends show access to reproductive endocrinology and fertility support services are an increasingly important public health problem,” Moen said.

Moen and colleagues used Epic Cosmos to get a broader view of fertility preservation support among this population.

The study included 279,562 women aged 18 to 40 years diagnosed with incident cancer between 2015 and 2025.

Patient characteristics associated with fertility preservation support, defined as any counseling for preservation or procedures, served as the primary endpoint.

‘Optimize referrals’

Overall, 3.4% of patients used fertility preservation support.

Women who received support had a significantly higher likelihood of being younger, having private insurance, living in urban areas, being single or unmarried, and being diagnosed with blood or breast cancer, Moen said.

The number of women who had at least one fertility preservation visit increased considerably from 2015 (5.9 patients per 1,000) to 2025 (37.7 per 1,000).

Rates did not differ geographically in 2015, but they varied considerably in 2025. The West had the highest rate (56.4 per 1,000), followed by the Midwest (41.5 per 1,000), Northeast (35.6 per 1,000) and South (28.2 per 1,000).

Among women who received fertility preservation support, 72.3% had at least one visit with a counselor, and 42.1% had at least one procedure consultation.

Moen acknowledged study limitations, including having data from EPIC only.

“There are a couple important ways we might be missing fertility preservation support services,” she said. “One is if the patient receives support outside of the EPIC health system. Oftentimes, these clinics might not be participating in EPIC. If patients went outside the system to receive fertility preservation support, we wouldn’t see it. The other one would be under-documentation.”

Moen highlighted multiple barriers could be inhibiting fertility preservation support, including workforce shortages, physician and patient awareness, oncologist priorities in limited time with patients, and costs, but added future research should explore these issues further.

“There’s not enough in the literature right now for us to really understand what the barriers are so we can inform solutions,” she said. “However, we can help optimize referrals and use in a way that doesn’t impact their cancer treatment trajectory and timeline is important.”

For more information:

Erika L. Moen, PhD, MS, can be reached at erika.l.moen@dartmouth.edu.