Current status and influencing factors of fertility preservation in pediatric and adolescent patients undergoing hematopoietic stem cell transplantation in China

Current studies reporting the status of fertility preservation in oncology patients mostly focus on patients with breast cancer and adult patients. Few studies have focused on blood disorders or pediatric and adolescent patients. To investigate the current status of fertility preservation and its influencing factors in pediatric and adolescent patients with hematological disease who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) in China. Adolescent and pediatric (< 18 years at diagnosis) patients who completed allo-HSCT at our center were investigated. A questionnaire was developed to collect patients’ sociodemographic information and fertility preservation status. A logistic regression model was applied to explore the factors influencing the current status of fertility preservation. A total of 190 subjects were investigated, including 78 (41%) females and 109 (56%) acute leukemia patients. The median age at diagnosis was 7 (0, 17) years. A total of 54% and 66% of patients were aware of and concerned about fertility preservation, respectively. A total of 20% and 4% of patients were counseled and underwent fertility preservation, respectively. Female sex (Odds Ratio, OR = 2.0, p = 0.031) and annual household income of ¥ (Chinese Yuan) 100,000-500,000 (OR = 3.7, p = 0.003, annual income<¥100,000 as the reference group) were significantly associated with higher awareness rates. Having health insurance (OR = 5.0, p = 0.004) and predisease fertility intentions (OR = 12, p < 0.001) were significantly associated with higher concern rates. Urban residence (OR = 3.3, p = 0.005) and annual household income of ¥100,000-500,000 (OR = 2.8, p = 0.021) were significantly associated with higher counseling rates. Aplastic anemia (OR = 8.2, p = 0.023, acute leukemia as the reference group) was significantly associated with higher rates of undergoing fertility preservation. The high rates of concern about fertility preservation are inconsistent with the low rates of awareness, consultation and actual use of fertility preservation methods. The fertility preservation status is unevenly distributed among patients of different genders, diseases, ages, regions, incomes, and health insurance statuses. The urgency of initiating therapy for hematological disorders is an important reason for the suboptimal status of fertility preservation.