Cryopreservation of reproductive material before cancer treatment: a qualitative study of health care professionals' views about ways to enhance clinical care.

BACKGROUND: Cancer treatment can diminish fertility in women and men. The need for fertility preservation is growing as increasing numbers of people survive cancer. Cryostorage of reproductive material to preserve potential for conception for cancer survivors has moved from being experimental to being a part of clinical management of women and men who are diagnosed with cancer in their reproductive years. There is little existing evidence about how fertility preservation services can be enhanced to meet the complex needs of patients who are diagnosed with cancer in their reproductive years. The aim of this research was to inform clinical practice development by drawing on the collective experience and knowledge of staff at well-established clinics that offer fertility preservation before cancer treatment. METHODS: A qualitative research model was adopted using semi-structured interviews with professionals involved in the care of people who freeze reproductive material before cancer treatment. In the state of Victoria, Australia, two large assisted reproductive technology (ART) centres have been providing fertility preservation services for more than two decades. An invitation to participate in a semi-structured interview about clinical care in the context of fertility preservation was emailed to past and current staff members. To capture diverse perspectives, informants were sought from all relevant professions: fertility specialists, andrologists, nurses, embryologists/scientists, counsellors, and administrative staff. Transcripts were analysed thematically. RESULTS: Thirteen key informants were interviewed from August 2013 to February 2014. The identified themes relating to enhancing clinical care in a fertility preservation service were communication between oncology and ART specialists; managing urgency; managing patients' expectations; establishing and implementing protocols, systems, and data bases; and maintaining contact with patients. CONCLUSION: The collective knowledge of this study's informants, who represent multidisciplinary teams with more than two decades' experience in fertility preservation, yields important insights into strategies that fertility preservation services can employ to promote the integration of oncology and fertility care, the psychosocial care of patients, data recording and monitoring, and reporting of outcomes.

Fertility management after breast cancer diagnosis: a qualitative investigation of women's experiences of and recommendations for professional care.

Breast cancer and its treatment in reproductive-age women can reduce fertility and compromise family formation. To learn about women's experiences of fertility-related cancer care we interviewed 10 women (aged 26-45), at least one year postdiagnosis. Thematic analysis revealed that all women, including one who chose to be child-free, valued fertility and motherhood. They reported experiencing varied fertility-related care, from support for fertility preservation to apparent disregard of their fertility concerns. Women's needs were heterogeneous, but all wanted health care providers to communicate fertility options and avoid assumptions about women's fertility desires while working to extend each woman's life.