Zip Code Overdiagnosis: Disparities in Fertility Preservation for Young Patients

Background: Ovarian tissue cryopreservation (OTC) is the only fertility preservation (FP) option available for prepubertal patients and has been endorsed by major medical societies. While disparities in adult FP care are well documented, the impact of social determinants of health on pediatric OTC utilization remains poorly understood. Methods: We conducted a retrospective study of 228 pediatric patients (≤14 years) referred for OTC from January 2011 to March 2023 at the University of Pittsburgh Medical Center and 19 collaborating U.S. centers. Analyses included: (1) comparison of OTC utilization per capita based on payment modality (Center-funded vs. Non-center-funded; n = 208), (2) association between socioeconomic status, assessed by the Distressed Communities Index (DCI), and OTC utilization ( n = 186); (3) demographic predictors of OTC uptake ( n = 62). DCI scores were derived from patient zip codes. Results: OTC utilization was 2.12 times higher at centers offering Center-funded services compared with those requiring payment. Patients in the Center-funded group had significantly higher median DCI scores (49.66 [18.22–67.01]) than the Non-center-funded group (26.99 [10.53–56.58]; p = 0.035), indicating greater socioeconomic disadvantage. Younger age was associated with lower OTC utilization (median age 2.00 years [1.25–6.00] for non-users vs. 8.00 years [4.00–11.00] for users; p = 0.016). Conclusions: Financial barriers, including socioeconomic disadvantage and out-of-pocket costs, significantly reduce pediatric OTC utilization. Additionally, younger patients are less likely to undergo OTC. Addressing these disparities through policy reform and financial support programs is critical to ensuring equitable access to FP care.