Big Geographic Access Gaps for Oncofertility Services in US

Megan Brooks

August 21, 2023


More than 3.6 million women of reproductive age lack access to fertility clinics offering standard fertility preservation services before cancer treatment, a new study shows.


  • In this cross-sectional analysis, researchers identified 370 fertility centers in the US (361 in the continental US) that provide oncofertility services and that met criteria for an oncofertility center.

  • Clinics were considered oncofertility centers if they offered oocyte cryopreservation, had performed at least one fertility preservation cycle in 2018, reported serving people without partners, and had an embryology laboratory that was accredited per CDC guidelines.

  • Researchers then quantified the number of young women potentially eligible for oncofertility services who lived farther than 2 hours from an oncofertility center.

  • In a secondary analysis, the team assessed the association between geographic access and state fertility preservation insurance mandates.


  • Overall, 3.63 million (5.7%) young women of reproductive age in the US (aged 15 to 44) live more than 2 hours from an oncofertility center.

  • The greatest gaps in access are in the Mountain West, West North Central, and Southwest regions; for instance, in Montana, North Dakota, and Wyoming, fewer than half of the at-risk population has geographic access to an oncofertility center.

  • Among the 11 states with fertility preservation insurance mandates, 98.5% of at-risk women have geographic access to an oncofertility center; in the 17 states without fertility preservation legislation, 79.6% of at-risk women have access to an oncofertility center.


Just over 3.6 million "reproductive-age female individuals lack geographic access to oncofertility services, especially in the Mountain West and West North Central regions," the authors concluded. "Significant geographic disparities in access to fertility preservation in the US require strategic expansion of care, especially given the growing demand for oncofertility services."


The study, led by Benjamin Peipert, MD, with Duke University School of Medicine, Durham, North Carolina, was published online August 10 in JAMA Oncology.


The authors relied on clinic data reported to the CDC, made assumptions about reasonable travel time, and may have underestimated access in some areas.


The study had no commercial funding. The authors have disclosed no relevant financial relationships.

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