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

Background: 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. Objectives: To synthesize the evidence on (1) global fertility preservation utilization rates and (2) factors associated with fertility preservation uptake among young breast cancer patients. Methods: statistic. The certainty of evidence was evaluated with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results: = 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. Conclusions: 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.