Young Cancer Patients Still Dream of Parenthood, but Many Never See a Fertility Specialist

A cancer diagnosis in your twenties or thirties forces a collision between two timelines: the urgent countdown to begin treatment and the long, unhurried timeline you had imagined for building a family. For adolescent and young adult patients, defined in oncology as those diagnosed between the ages of 18 and 39, this collision is not hypothetical. Many of the therapies that save their lives, including gonadotoxic chemotherapy regimens, pelvic radiation, and certain hormone treatments, can permanently impair fertility. Yet a new study of nearly five thousand young cancer patients suggests that the conversation about preserving that possibility is still reaching only a fraction of the people who want it, and that the patients most likely to want children are not always the ones clinicians might predict.

The research, led by Paige W. Lake of the Health Outcomes and Behavior program at the H. Lee Moffitt Cancer Center and Research Institute in Tampa, Florida, together with colleagues at Moffitt and New York University’s Grossman School of Medicine, was published in Supportive Care in Cancer. Rather than surveying a small, selected clinic population, the team tapped into something far more powerful: a large-scale electronic patient questionnaire administered at clinical intake, paired with cancer registry data that documented each patient’s diagnosis and treatment. This design allowed the investigators to examine, across thousands of consecutive patients, who wanted future children and who, among those wanting or uncertain about children, expressed interest in meeting with a fertility specialist.

The scale of the dataset is one of its defining strengths. A total of 4,847 adolescent and young adult patients completed the questionnaire, a group that was 62 percent female with an average age of 32 years. The questionnaire captured self-reported physical and mental health alongside two deceptively simple questions: whether the patient desired future children, and whether they would be interested in a consultation with a fertility specialist. Linking these responses to registry-recorded cancer characteristics, including tumor type and treatment modalities such as chemotherapy, hormone therapy, and transfusions, gave the researchers a multidimensional picture of reproductive priorities at the moment of diagnosis, before treatment had begun to reshape them.

The statistical approach was correspondingly rigorous. To identify the factors associated with the desire for future children, the team used multinomial regression, an analysis that can distinguish between patients who want children, those who do not, and those who are genuinely undecided, rather than collapsing uncertainty into a binary answer. A second, binary regression analysis was then restricted to the subset of patients who wanted children or were unsure, asking which characteristics predicted interest in a fertility consultation. This two-stage design matters because it separates two distinct clinical questions: who values the possibility of biological parenthood, and who wants expert help in protecting it. The answers, as it turned out, did not overlap neatly.

The first stage produced a pattern that will feel intuitive to anyone who has watched family-building decisions unfold, but the effect sizes are striking. Female patients were significantly less likely than male patients to report wanting future children, with an odds ratio of 0.56, meaning their odds were nearly half those of men in the cohort. Age exerted a strong and steady effect: each additional year of age reduced the odds of wanting children by roughly 19 percent, with an odds ratio of 0.81 per year. And patients who already had children were far less likely to want more, with an odds ratio of 0.34, less than half the odds of child-free patients. In a cohort where the average patient was 32, these gradients mean that reproductive desire was concentrated among the youngest, child-free patients, precisely the group with the longest reproductive runway ahead of them and the most to lose from gonadotoxic treatment.

The second stage of the analysis revealed who, among those wanting or uncertain about children, actually wanted to sit down with a fertility specialist, and here the pattern inverted in a clinically important way. Older patients were more likely, not less, to express interest in a consultation, with an odds ratio of 1.04 per year of age. Women were more interested than men, with an odds ratio of 1.39. Diagnosis mattered as well: patients with breast cancer were more than two and a half times as likely to want a consultation, with an odds ratio of 2.65, and lymphoma patients nearly twice as likely, with an odds ratio of 1.99. Treatment type left its own signature. Those receiving hormone therapy had 73 percent higher odds of wanting a consultation, and patients who had received transfusions showed a markedly elevated estimate as well, with an odds ratio of 3.23, though the wide confidence interval around that figure, spanning 0.86 to 12.21, reflects a smaller number of patients in that category and demands cautious interpretation.

Why would the youngest patients, who most want children, be less inclined to seek specialist input, while older patients and those with breast cancer or lymphoma seek it out? Part of the answer likely lies in the structure of cancer care itself. Breast cancer and lymphoma are treated by oncology teams for whom fertility preservation referral has become increasingly routinized, supported by dedicated oncofertility programs and, more recently, by updated clinical guidelines from the American Society of Clinical Oncology that call for discussing fertility preservation options with patients before gonadotoxic therapy begins. Patients with these diagnoses are more likely to be asked the right questions at the right moment. Younger patients, meanwhile, may be processing an overwhelming new diagnosis, and the assumption, by clinicians or by the patients themselves, that youth equals fertility, can quietly close a door that should have been opened.

The biology underlying these conversations is unforgiving in its timing. Chemotherapy agents, particularly alkylating drugs and platinum compounds such as cisplatin, damage the rapidly dividing cells of the ovary and the spermatogonial stem cells of the testis. Pelvic and cranial radiation can disrupt the hypothalamic-pituitary-gonadal axis. In women, the ovarian reserve is finite and cannot regenerate, so a treatment that destroys a large fraction of remaining follicles can precipitate premature ovarian insufficiency, a risk that population-based studies have documented at elevated rates in young survivors of non-gynecological cancers. In men, sperm production can sometimes recover, but azoospermia after treatment is common enough that sperm cryopreservation before therapy remains the single most established preservation option. Oocyte and embryo cryopreservation, ovarian tissue banking, and ovarian suppression strategies offer women parallel but more complex pathways, each requiring days to weeks of lead time that a fast-growing cancer may not easily spare.

What makes the new findings actionable is that they identify exactly where the referral pipeline leaks. The authors conclude that there is a need to systematically address and offer fertility consultation to all adolescent and young adult patients prior to the initiation of treatment, rather than relying on ad hoc conversations whose frequency depends on diagnosis, age, and sex. The data suggest that a triage model keyed to diagnosis or age would miss patients who want help: a 38-year-old woman with breast cancer is more likely to ask for a consultation than a 24-year-old man with a diagnosis less associated with oncofertility services, even though the younger man may have the stronger desire for future biological children and the greater cumulative reproductive risk across his remaining life. Prior research in this field has consistently shown that fertility-related distress is common among young survivors, that pretreatment counseling is associated with improved quality of life, and that unaddressed reproductive concerns can influence later treatment decisions, including adherence to endocrine therapy in young breast cancer survivors who must weigh years of hormonal suppression against their shrinking window for pregnancy.

The study’s authors are careful to note that sociodemographic, clinical, and psychosocial factors warrant additional study and future intervention development to ensure that fertility needs are met, and the dataset has limitations inherent to its design: responses were self-reported at a single moment of acute stress, and the transfusion finding in particular rests on a small subgroup. But the central message survives those caveats intact. Nearly five thousand young patients told researchers, in their own words at the moment of diagnosis, that parenthood remains a live and urgent question for many of them, and that the desire for children does not automatically translate into access to the specialists who can protect it. Closing that gap will not require new drugs or new technology; the preservation options already exist. It requires making one conversation universal, systematic, and early, offered to every adolescent and young adult before the first infusion, so that the decision about whether to pursue fertility preservation belongs to the patient rather than to chance, diagnosis, or whoever happens to remember to ask.

Subject of Research: Desire for future children and interest in fertility specialist consultation among adolescent and young adult cancer patients

Article Title: Desire for future children and interest in consultation with a fertility specialist among adolescent and young adult (AYA) cancer patients

Article References: Lake, P. W., Zhao, Y., Amorrortu, R. P., Quinn, G. P., Rollison, D. E., & Vadaparampil, S. T. (2026). Desire for future children and interest in consultation with a fertility specialist among adolescent and young adult (AYA) cancer patients. Supportive Care in Cancer, 34(10), Article 1060. https://doi.org/10.1007/s00520-026-11313-6

Image Credits: AI Generated

DOI: 10.1007/s00520-026-11313-6

Keywords: adolescent and young adult oncology, fertility preservation, oncofertility, cancer, infertility, fertility consultation, breast cancer, lymphoma, reproductive health, patient-reported outcomes, supportive care, cancer registry