TitleTo preserve or not to preserve: how difficult is the decision about fertility preservation?
Publication TypeJournal Article
Year of Publication2013
AuthorsMersereau, JE, Goodman, LR, Deal, AM, Gorman, JR, Whitcomb, BW, H Su, I
Date Published08/2013
KeywordsAdult, Cohort Studies, Decision Making, Female, Fertility Preservation, Humans, Male, Neoplasms, Prospective Studies, Survivors

BACKGROUND: The decision to pursue fertility preservation (FP) after a cancer diagnosis is complex. We examined the prevalence of high decisional conflict and specific factors that influence this decision using the Decisional Conflict Scale (DCS).

METHODS: The FIRST project is a web-based survey of female cancer survivors (ages 18-44 years) who have undergone gonadotoxic treatment. We evaluated the association between recalled decisional conflict and referral to FP counseling and demographic, socioeconomic, and cancer variables.

RESULTS: Of 208 participants, 115 subjects (55%) had scores consistent with high decisional conflict (DCS score >37.5 of 100), and 43 (21%) were in the moderate range (25-37.5). In unadjusted analysis, high decisional conflict was associated with lack of referral to FP consultation, not undergoing FP treatment, concerns regarding FP cost, length of survivorship, lower income, education, partner status, and cancer type. In multivariable analysis, significantly higher prevalence of high decisional conflict was observed in participants who were not referred for FP consultation (prevalence ratio [PR], 1.25; 95% confidence interval [CI], 1.06-1.47), as well as in participants who reported cost of FP services to be prohibitive (PR, 1.16 [95% CI, 1.03-1.31]). Prevalence of high DCS was lower for women who underwent FP treatment (PR, 0.67 [95% CI, 0.52-0.86]).

CONCLUSIONS: In this study of female young adult cancer survivors, the majority recalled significant decisional conflict about FP at cancer diagnosis. Increasing access to FP via referral for counseling and cost reduction may decrease decisional conflict about FP for young patients struggling with cancer and fertility decisions.

Alternate JournalCancer
PubMed ID24037854
PubMed Central IDPMC3935984
Grant ListK23 HD058799 / HD / NICHD NIH HHS / United States
UL1 DE019587 / DE / NIDCR NIH HHS / United States
UL1 RR024926 / RR / NCRR NIH HHS / United States
HD-058799-01 / HD / NICHD NIH HHS / United States