Barriers to fertility preservation counseling in young cancer patients: A retrospective chart review.

e13732 Background: The possibility of infertility is a major concern for young cancer patients facing chemotherapy. While guidelines state that all patients diagnosed with cancer during their reproductive years should be referred to a fertility specialist, prior data confirm that many patients report never being granted that opportunity. Cancer treatment regimens have advanced significantly over the past few decades, leading to improved survival rates. As a result, fertility preservation counseling (FPC) has become an essential component of comprehensive treatment planning. By examining demographic factors and patient characteristics, this retrospective chart review aims to evaluate the factors that may influence a patient's likelihood of being referred for fertility preservation. Methods: Data were sourced from the electronic medical record at a single academic medical center and included patients diagnosed between May 1, 2018, and May 31, 2025. Eligible patients were between the ages of 18 and 40 at the time of diagnosis. Exclusion criteria included past medical history of genetic disorders that predispose to infertility, and/or a history of hysterectomy, tubal ligation, or vasectomy. Variables that were collected and analyzed included age, sex, cancer type, cancer stage, race/ethnicity, marital status, zip code, and chemotherapy risk level. Zip codes were utilized as a proxy for median household income. Documentation of FPC or fertility referral was extracted as a variable, which was utilized as the primary outcome. A multivariable logistic regression model was implemented using RStudio to evaluate how these factors were associated with FPC. Results: Among 308 patients, 214 (69. 48%) had a documented fertility referral or counseling in their medical record, while 94 (30. 52%) patients did not. Based on a multivariable logistic regression model, lower household income was associated with reduced odds of fertility referral (OR=0. 779). Although higher income levels were associated with increased fertility referral rates (64. 2% in 50k–99k vs 72. 6% in 100k–149k vs 92. 3% in ≥150k), these differences did not reach statistical significance (p = 0. 144). In contrast, age, race, marital status, cancer type, and stage showed little association with fertility referral. Conclusions: Although no variables were statistically significant, observed differences regarding household income still suggest potential disparities in fertility referral practices. Additionally, there should be further exploratory analysis to understand why a third of young cancer patients remained without FPC amidst gonadotoxic chemotherapy. Future work will examine provider-level factors, including physician gender, to assess whether referral practices differ between male and female clinicians and may influence access to fertility preservation services.