Global uptake of fertility preservation by women undergoing cancer treatment: An unmet need in low to high-income countries

1Introduction

The incidence of cancers continues to rise globally with an estimated 19.3 million new cases in 2020 [1] . Due to aging and growing populations with an increasing prevalence of risk factors, the global incidence of cancers is expected to continue to rise with a projected incidence of 28.4 million by 2040 [12] . Women make up 49.6% of the world’s population and account for 9.2 million (47.7%) of the new cases of cancer in 2020 [1] . An estimated 1 in 17 females under the age of 49 years is expected to develop invasive cancer [3] .

With advances in early detection and treatment, cancer mortality has continued to decrease globally over the past two decades [4] . On the other hand, cancer treatments such as chemotherapy and radiotherapy are often associated with many undesirable adverse events including an impact on the reproductive capacity of cancer survivors. Premature ovarian failure and subsequent infertility are established complications of these interventions, as a result, are of major concern to most women undergoing cancer treatment [5] . The emotional toll of cancer diagnosis could be compounded by the fear of partial or complete loss of fertility leading to a reduction in quality of life [6] . This risk of infertility depends on the type of cancer, age of the patient, type of treatment, fertility preservation window before initiation of cancer treatment, and risk of metastasis to the ovaries [7] . Fertility preservation options such as oocyte and embryo cryopreservation and other evolving experimental treatments are available to women with cancers [8] .

Despite the significance of fertility preservation in cancer care and the recent advances in assisted reproduction technologies, many women across the world are unaware of the availability of these services or have no access to them. This study, therefore, describes the options of fertility preservation, as well as availability and uptake in low, middle, and high-income countries. We also discuss factors influencing fertility preservation uptake and outline a pragmatic approach to address this unmet need of women with cancers who are facing the prospect of losing their fertility.