Grant Number:	1R03CA308545-01 Interpret this number
Primary Investigator:	Housten, Ashley
Organization:	Washington University
Project Title:	Aya Pathways: Characterizing Costs of Fertility Preservation Options for Adolescent and Young Adult Cancer Survivors
Fiscal Year:	2026

Project Summary Across the US, there are over 2 million AYA cancer survivors and that number continues to grow. About 80% of AYAs diagnosed with cancer become long-term survivors with many living well into adulthood. With the growing number of AYA cancer survivors, survivorship planning is crucial and includes quality of life considerations, like fertility preservation. Several cancer types and treatments can cause infertility, and the negative effects of infertility-related distress can be devastating and long-lasting—particularly for AYAs. Fertility preservation methods for young men include sperm banking and testicular tissue freezing. For young women, there are several medically-appropriate therapies, including egg freezing and ovarian tissue freezing. These therapies are effective, but may also be costly, as only about 20 states mandate insurance coverage for fertility preservation. Yet, many AYAs may still not qualify for coverage as they often do not meet infertility requirements until they reach adulthood. Additionally, some procedures can take up to two weeks, potentially delaying the start of cancer treatment. Therefore, choosing the “right” fertility preservation method for each AYA and their family is preference-sensitive. Specifically, this decision depends on both the medical evidence and the informed, values-concordant preferences of the patient. With the multitude of costs related to AYA cancer care, financial hardships are detrimental to the financial wellbeing of many AYAs and their families. Financial hardship is serious and associated with diminished health-related outcomes and quality of life among cancer survivors. We propose characterizing the costs of AYA fertility preservation care, including the direct financial burden from out-of-pocket fees and the unforeseen indirect costs like transportation and time off work for parents. We will incorporate our findings into Pathways for AYA to support AYAs and their families as they decide whether to undergo fertility preservation and which fertility preservation option is right for them. Incorporating fertility preservation cost information to improve informed decision-making by engaging with AYAs, their parents, and clinicians has the potential to prepare patients and their families for making well- informed decisions to improve quality of life into survivorship.





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