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This retrospective cohort study evaluated pregnancy and fertility-care use in 18–45-year-old women with incident invasive cancer from U.S. datasets, assessing variation by age, parity, race, and social vulnerability.",{"@graph":14,"@context":72},[15,34,55],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/research-report/","Research & 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cohort.",{"name":69,"@type":60,"acceptedAnswer":70},"What were the main findings regarding pregnancy and fertility services after cancer?",{"text":71,"@type":63},"Cancer survivors had fewer and more delayed pregnancies than controls and showed persistently low absolute uptake of fertility-preserving care, with higher relative rates of fertility evaluation, testing, and preservation after diagnosis.","https://schema.org",{"og:url":32,"og:type":74,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":76,"canonical":32},"index,follow",{"doc_id":78,"site_id":7},351389,1790176999,{"code":4,"msg":81,"data":82},"success",[83,87,91,95,100,105,110,114,119,122,126],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":84,"show_sort_weight":85,"slug":86},"Story & 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Women  \nVolume 17: 1–10 © The Author(s) 2026 Article reuse guidelines:  \n[sagepub.com/journals-permissions](sagepub.com/journals-permissions)[ ](sagepub.com/journals-permissions)[DOI: 10.1177/21501319261437902](DOI: 10.1177/21501319261437902)[ ](DOI: 10.1177/21501319261437902)[journals.sagepub.com/home/jpc](journals.sagepub.com/home/jpc)  \nAzza Sarfraz 1, Selamawit Woldesenbet 1, Odysseas P. Chatzipanagiotou 1, Areesh Mevawalla 1, Qaidar Alizai 1, Rida Ejaz 1, Abdullah Altaf1, Mujtaba Khalil 1, Zayed Rashid 1, and Timothy M. Pawlik 1  \nAbstract  \nIntroduction: Advances in oncologic therapy have extended survival among women of reproductive age, repositioning fertility and family-building as core survivorship concerns. Population-level data on post-diagnosis pregnancy and real-world fertility-care utilization across cancers remain limited. This study evaluated post-diagnosis pregnancy and fertility-care utilization among reproductive-aged women (18-45 years) with incident invasive cancer and examined variation by age, parity, race, and neighborhood social vulnerability.  \nMethods: We conducted a retrospective cohort study using 2 large U.S. datasets. The primary cohort was drawn from IBM MarketScan (2013-2018). A validation cohort was assembled using Epic Cosmos (2018-2021), an electronic health recordbased patient registry. Women aged 18 to 45 years with incident invasive cancer were matched to cancer-free controls. The main exposure was incident cancer diagnosis. The primary outcome was subsequent pregnancy after diagnosis, with secondary outcomes including fertility evaluation, fertility testing, and fertility preservation. Hazard ratios (HRs) and 95% confidence intervals (CIs) measured associations, including subgroup analyses by parity, age, race, and social vulnerability. Results: In the MarketScan cohort, pregnancy occurred in 103 (2.3%) survivors versus 388 (4.5%) controls (HR = 0.47, 95% CI = 0.38-0.59). Survivors had higher rates of fertility evaluation (42 [0.9%] vs 25 [0.3%]; HR = 3.00, 95% CI = 1.81- 4.97), fertility testing (1759 [39.7%] vs 1031 [11.9%]; HR = 4.23, 95% CI = 3.91-4.58), and fertility preservation (34 [0.8%] vs 25 [0.3%]; HR = 2.36, 95% CI = 1.39-4.00), although absolute preservation rates remained low. Associations were strongest among nulliparous women (pregnancy HR = 0.50, 95% CI = 0.37-0.69). Increasing age reduced pregnancy (HR = 0.75, 95% CI = 0.73-0.78) and preservation (HR = 0.86, 95% CI = 0.80-0.92). No racial or neighborhood social vulnerability trends were identified. Results were replicated in the Cosmos validation cohort, with consistently higher fertility evaluation (HR = 7.47), testing (HR = 5.54), and preservation (HR = 6.56) after cancer diagnosis.  \nConclusions: Among reproductive-aged women, cancer diagnosis was associated with fewer and delayed pregnancies and persistently low absolute uptake of fertility-preserving care, particularly among nulliparous and older patients. These findings highlight the need for early, standardized onco-fertility counseling, automatic pre-treatment referral for patients undergoing gonadotoxic therapy, and policies designed to mitigate barriers to fertility care.  \nKeywords  \noncofertility, cancer survivorship, fertility preservation, obstetrics, health inequities  \nReceived: November 28, 2025; revised: March 15, 2026; accepted: March 16, 2026  \nIntroduction  \nCancer among women of reproductive age represents an important and growing public health concern in the United States. A spectrum of malignancies can occur during the reproductive years, including breast, endometrial, gastrointestinal, lung, neuroendocrine, ovarian, thyroid, and genitourinary cancers.1 Breast cancer remains the most commonly  \n1 The Ohio State University, Columbus, USA  \nCorresponding Author:  \nTimothy M. Pawlik, Department of Surgery, Wexner Medical Center,","cbCaicgF7eMR2bWI","https://ap.wps.com/l/cbCaicgF7eMR2bWI","pdf",725081,"English","# Abstract\n# Introduction\n## Background and public health context\n# Methods\n## Study design and data sources\n## Outcomes and statistical approach\n# Results\n## Pregnancy after diagnosis\n## Fertility evaluation, testing, and preservation\n## Subgroup and validation analyses\n# Conclusions\n## Clinical implications and policy needs","[{\"question\":\"What question does the study address about cancer and reproduction?\",\"answer\":\"The study evaluates post-diagnosis pregnancy and fertility-care utilization among reproductive-aged women with incident invasive cancer, and examines how use varies by age, parity, race, and neighborhood social vulnerability.\"},{\"question\":\"How was the study conducted and what data sources were used?\",\"answer\":\"A retrospective cohort design was used with two large U.S. datasets: IBM MarketScan (2013–2018) as the primary cohort and Epic Cosmos (2018–2021) as a validation cohort.\"},{\"question\":\"What were the main findings regarding pregnancy and fertility services after cancer?\",\"answer\":\"Cancer survivors had fewer and more delayed pregnancies than controls and showed persistently low absolute uptake of fertility-preserving care, with higher relative rates of fertility evaluation, testing, and preservation after diagnosis.\"}]","Impact of Cancer on Pregnancy and Fertility Service Use in Reproductive-Aged Women - Journal Article | PDF",1790093962,25]