# Racial and Ethnic Disparities in Fertility Preservation for Women with Cancer in the United States—Identifying Systemic Barriers and Proposing Solutions Through the DART Hypothesis

## TL;DR

This paper reviews racial and ethnic disparities in fertility preservation for cancer patients in the US and proposes solutions using the DART hypothesis.

## Contribution

The paper introduces the DART hypothesis as a framework to address systemic barriers in fertility preservation for minority cancer patients.

## Key findings

- Racial and ethnic minorities face multiple bottlenecks in accessing fertility preservation services.
- Disparities persist despite increased use of assisted reproductive technology in the US.
- The DART hypothesis identifies key pathways for improving equity in fertility care.

## Abstract

This narrative review article focuses on disparities in fertility preservation of women from racial and ethnic minority groups diagnosed with cancer. We discuss the multiple bottlenecks and delays that occur from the time of diagnosis, and initial counseling, to surgical treatment, to referral to a fertility specialist, and finally to access/utilization of fertility preservation services. We also suggest possible solutions to bridge these gaps using the DART hypothesis as a template.

Continuing advances in cancer diagnosis and treatment, particularly in reproductive-aged patients, has led to numerous national medical organizations, including the American Society for Reproductive Medicine (ASRM), the American College of Obstetrics and Gynecology (ACOG), and the American Society for Clinical Oncology (ASCO), recommending prompt discussion of the potential gonadotoxic effects of chemotherapy and referral to a fertility specialist for counseling regarding possible fertility preservation. Despite overall increased utilization of assisted reproductive technology (ART) in the United States (US), racial and ethnic disparities persist on a multisystem level, ranging from decreased access and utilization of ART to inconsistent and delayed counseling to worse outcomes. While innovations in ART and cancer treatment continue to evolve in parallel, the beneficial impacts have been disparate and more limited in minority populations. This review specifically highlights racial and ethnic disparities in fertility preservation for women with cancer in the United States, highlights the underdeveloped state of this literature, and identifies possible pathways for improvement using the Disparities in Assisted Reproductive Technology (DART) hypothesis as a template. We address three main bottlenecks resulting in delay from time of cancer diagnosis to utilization of fertility preservation services.