Barriers and facilitators to accessing fertility preservation services in adolescent and young adult cancer survivors: A systematic review.

340Background: As oncology interventions advance, infertility continues to be a significant concern for adolescent and young adult (AYA; ages 15-39) cancer survivors. However, accessing fertility preservation (FP) services in the United States remains a complex and often challenging process. This review aims to identify key facilitators and barriers for AYA cancer survivors in accessing FP in the United States. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a systematic review across PubMed, Embase, and CINAHL databases for literature published between 1/2015-4/2025. Included studies discussed barriers and/or facilitators to FP for AYA cancer survivors. Studies were excluded if they were completed outside of the United States or focused on outcomes of treatment, surgery, or clinical procedures. Themes from each article were categorized into survivor, provider, or system level facilitators and barriers. Results: A total of 12 studies were included in this review, comprising qualitative (n = 5) and mixed-methods studies (n = 2), along with cohort studies (n = 2), cross-sectional studies (n = 2), and one comparative/psychometric validation study (n = 1). Key facilitators of FP access included insurance coverage, informed providers, patient and family advocacy, financial support resources, and system-level tools such as EHR integration and institutional commitment. Key barriers to FP access included prohibitive costs, lack of insurance coverage, limited provider knowledge, inequities related to social determinants of health, and inconsistent institutional support. Data from three studies indicated that, depending on insurance coverage, the average out-of-pocket cost for embryo or oocyte cryopreservation for survivors ranged between $10, 000 and $15, 000. The most frequently reported theme across all studies were systemic barriers, including fragmented care, lack of standardized processes, and imbalanced access to information and resources. Conclusions: This systematic review underscores the importance of securing access to FP for the AYA cancer survivors by addressing disparities in survivor access to information, provider training, and system-level care coordination. Multi-level interventions are needed to support equitable and survivor-centered FP goals for AYAs as standard practice in cancer care.