Barriers to fertility preservation among cancer patients in the Middle East and North Africa (MENA) region: a scoping review

INTRODUCTION: Advances in cancer care have increased survival and demand for quality cancer survivorship care. Among survivors of reproductive age, the sequelae of gonadotoxic cancer treatments such as infertility presents a key survivorship and quality-of-life concern. In the Middle East and North Africa (MENA) access to fertility preservation (FP) services is inadequate, limiting future fertility and dreams of childbirth. PURPOSE: To synthesize scientific literature to identify the barriers to FP among cancer patients in the MENA region. METHODS: Database searches (PubMed, Scopus, Web of Science, Google Scholar, CINAHL, and ProQuest) of articles about FP/oncofertility barriers (January 2015 and June 2025) yielded 243 articles. Articles were included only if they focused on cancer patients or addressed parents and healthcare providers of patients with cancer eligible for FP (n = 22). RESULTS: Content analysis led to four themes of patient, provider, healthcare system, and socio-cultural related barriers. The key patient-related barriers were lack of knowledge about FP and fear of delaying cancer treatment. The common provider-related barriers were inadequate knowledge and confidence about FP, poor patient teaching, and biases. The main healthcare system barriers were cost and lack of access to FP services. The key social-cultural barriers were the hindrances arising from social norms, cultural values, and religious beliefs about FP. CONCLUSION: Cancer patients in the MENA region face complex intersecting barriers to FP. These challenges may differ from one country to another, but require multidisciplinary culturally informed approaches that integrate education, policy reforms, and religious engagement. We highlight future directions to aid equitable access to FP for cancer survivors. IMPLICATIONS FOR PRACTICE: Improving access to FP for cancer patients and survivors in the MENA region requires culturally sensitive, multidisciplinary interventions. Entrenched systems to ensure early FP counseling, provider education and training, and patient education about FP are a reasonable starting point.