Racial and Ethnic Disparities in Fertility Preservation for Women with Cancer in the United States—Identifying Systemic Barriers and Proposing Solutions Through the DART Hypothesis

Continuing advances in cancer diagnosis and treatment, particularly in reproductive-aged patients, has led to numerous national medical organizations, including the American Society for Reproductive Medicine (ASRM), the American College of Obstetrics and Gynecology (ACOG), and the American Society for Clinical Oncology (ASCO), recommending prompt discussion of the potential gonadotoxic effects of chemotherapy and referral to a fertility specialist for counseling regarding possible fertility preservation. Despite overall increased utilization of assisted reproductive technology (ART) in the United States (US), racial and ethnic disparities persist on a multisystem level, ranging from decreased access and utilization of ART to inconsistent and delayed counseling to worse outcomes. While innovations in ART and cancer treatment continue to evolve in parallel, the beneficial impacts have been disparate and more limited in minority populations. This review specifically highlights racial and ethnic disparities in fertility preservation for women with cancer in the United States, highlights the underdeveloped state of this literature, and identifies possible pathways for improvement using the Disparities in Assisted Reproductive Technology (DART) hypothesis as a template. We address three main bottlenecks resulting in delay from time of cancer diagnosis to utilization of fertility preservation services.