Oncofertility Care Delivery in the French Departments of the Americas: A Multi-Source Comparative Study of Regional Disparities, Organisational Challenges and Future Directions

Abstract Background Fertility preservation is a core component of comprehensive cancer care, but its delivery can be uneven in geographically isolated settings with limited specialised resources. This study examined the organisation and reported activity of oncofertility services in Martinique, Guadeloupe and French Guiana, and compared territorial patterns with mainland France. Methods This multi-source descriptive study combined a structured narrative review of scientific publications, institutional reports and national and international guidelines published between 2007 and 2025 with a comparative analysis of aggregated cancer incidence and medical fertility preservation activity for 2018–2022. Procedure-to-incident cancer case ratios were calculated for corresponding age- and sex-specific groups. These ecological indicators were used only as descriptive proxies of activity and were not interpreted as coverage, uptake or cancer-specific procedure rates. Results The overall medical fertility preservation procedure-to-incident cancer case ratio was 17.3 procedures per 100 incident cancer cases in mainland France, compared with 6.2 in Guadeloupe, 1.8 in Martinique and 0.0 in French Guiana. Specialised fertility preservation services were concentrated in Guadeloupe. Martinique had limited private local capacity during the study period, whereas French Guiana relied on interterritorial referrals. The review identified geographical distance, logistical constraints, workforce shortages, variable professional awareness and fragmented referral pathways as the main organisational barriers. Conclusions Despite a common regulatory framework, oncofertility care delivery differed markedly across the French Departments of the Americas. Stronger interterritorial coordination, clearer referral pathways, professional training and local or satellite fertility preservation capabilities are needed to support more equitable and timely care in island and peripheral settings.