Global disparities in fertility preservation among young breast cancer patients: a systematic review and meta-analysis of utilization rates and associated factors.

Authors

Jingwen Yan, Yanhui Zhang, Ziqing Yang

Published in

International journal of nursing studies advances. Volume 11. Pages 100691. Epub Sep 28, 2026.

Abstract

Women who develop breast cancer at the age of 40 years or younger often face considerable barriers to fertility preservation services. This systematic review and meta-analysis examined global fertility preservation utilization rates and the factors associated with uptake.
To synthesize the evidence on (1) global fertility preservation utilization rates and (2) factors associated with fertility preservation uptake among young breast cancer patients.
We systematically searched five databases (PubMed, EMBASE, Cochrane Library, CINAHL, PsycINFO) and trial registries for studies published from January 2010 to August 2026 involving women aged 40 years or younger with breast cancer. Proportions and odds ratios (ORs) were pooled using random-effects meta-analysis, and heterogeneity was assessed with the I² statistic. The certainty of evidence was evaluated with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.
Eighteen studies (n = 13,394) were included. The pooled fertility preservation utilization rate was 26.8% (95% CI: 20.0-34.1%; I² = 98.8%). Regional estimates differed widely (Europe 47.8%; Asia 19.8%; North America 14.0%), but the North American estimate was highly imprecise (95% CI: 5.0-26.6%; I² = 99.3%), so regional comparisons should be interpreted with caution. Older age within the young-patient range (OR 0.71), higher educational attainment (OR 1.58), being partnered (OR 1.74), nulliparity (OR 2.12), and insurance coverage (OR 2.85) were associated with uptake, with specialist referral the strongest enabling factor (OR 4.26). The certainty of evidence was rated low to very low across outcomes.
Access to fertility preservation appears inequitable worldwide, although substantial heterogeneity and imprecision in some regional estimates preclude definitive cross-regional rankings. Younger age, higher education, partnership status, and insurance coverage were associated with fertility preservation uptake. Because the evidence is observational and heterogeneous, causal inferences should be drawn with caution. Policy reforms supporting insurance coverage and standardized training may improve access to fertility preservation, but further high-quality research is needed.

PMID:
42860957
Bibliographic data and abstract were imported from PubMed on 12 Oct 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.