Hematopoietic Cell Transplantation and Utilization of Fertility Preservation Services

Conditioning regimens for hematopoietic cell transplantation (HCT) are harmful to reproductive function, but national utilization of fertility preservation (FP) before HCT has not been studied. The primary aim of this descriptive retrospective analysis is to understand FP utilization in the HCT population of patients between ages 18 and 40 years, whereas the secondary aim is to describe temporal trends in FP before HCT. Key dates, procedures codes, and diagnosis codes were extracted from administrative and health services commercial claims data, which were obtained from FAIR Health's national claims database, to construct 29 patient-specific clinical journey timelines detailing the time from diagnosis to FP and to HCT. Patient characteristics studied include sex, age, HCT type (autologous and allogeneic), and census region. Key findings from primary and secondary analyses were that 7% of the HCT cohort had claims for FP services, FP utilization before HCT decreased with increasing age, there were 102 days (median) between FP and HCT procedure date, and 7 of 29 patients who received FP services had a nonmalignant primary indication for HCT. More research is needed to understand the barriers to FP before HCT so that targeted tools can be used to increase utilization and improve quality of life for HCT survivors.