Parenthood after Cancer in Puerto Rico: Barriers and Facilitators to Accessing Fertility Preservation Technologies

Background:  Infertility is a common side effect of certain cancer treatments, and fertility preservation—including egg, embryo and sperm cryopreservation—can help recently-diagnosed patients protect the possibility of genetic parenthood post-treatment.  However, access to these options remains difficult for low-income and minority groups in the U.S.

Objective:  This paper aims to describe the barriers and facilitators that influence access to fertility preservation by cancer patients in Puerto Rico, an unincorporated U.S. territory.

Methods:  Sixty (60) in-depth, semi-structured interviews were conducted with healthcare providers, cancer survivors, researchers, and advocates as part of an anthropological study on cancer survivorship and reproduction in Puerto Rico.

Findings:  Various fertility preservation techniques are available through four clinics; however, they are rarely used by cancer patients on the island.  Analyses identified several barriers that impede access: (1) high cost and lack of insurance coverage, especially in relation to income levels; (2) gaps in provider knowledge of fertility clinics and financial assistance programs; (3) low prioritization of quality-of-life needs by providers, leading to inconsistent disclosure of fertility risks; and (4) geographical location of fertility clinics.  Several facilitators indicate potential areas of intervention: both physicians and patients place a high value on communication and time spent together, and new alliances are being formed between the oncology and reproductive medicine fields on the island.

Conclusion:  Fertility preservation and parenthood form part of emerging discussions in Puerto Rico about quality-of-life following cancer.  Greater awareness of these issues can be created through physician training and organizational measures targeting cost barriers.