Uncertain Fertility Research Articles

A qualitative study on self‐image, mental well‐being and fertility among female young adult childhood cancer survivors

AbstractIntroductionYoung female adult childhood cancer survivors have frequently been reported to be concerned about their health, in particular their future fertility. The aim of this study was to examine how self‐image, mental health and perceptions of the fertility of young female adults are affected by the illness.MethodsA qualitative study with interviewer‐administered semistructured questions was performed from May 2018 to October 2020 at Sahlgrenska University Hospital, Sweden. Fourteen women participated in the study. The median age of the participants was 27 (25–31) years.ResultsThe interviews were recorded and analysed inductively by a thematic approach. Forty‐one codes were created, of these 21 initial codes were found to be related to the aim of the present study. Subsequently, four broad themes were created and these were reanalysed and constituted three main themes, resulting in the labelling: ‘An experience for better and worse’, ‘An everyday life similar and yet different from peers’ and ‘An uncertain fertility’, and a relevant number (11) of inclusive subthemes. Participants expressed that the experience of surviving childhood cancer both strengthened and impaired their everyday life and implied the lack of information about fertility.ConclusionsAlthough a long time, over 10 years, had passed since the cancer treatment for all participants, the experiences of the illness were still present in their lives, both for better and worse. Healthcare workers need to keep this complexity in mind when facing young childhood cancer survivors. Thus, there is a need for individualized support regarding fertility and mental health.

The New Fiscal and Tax Policies Promote the Path of Fertility Level Improvement

In view of the current highly complex and uncertain fertility environment, China has adopted a gradual fertility policy adjustment strategy, but China's birth rate still shows a fluctuating downward trend, and there is still a long way to go to improve the relevant supporting measures of fertility support to promote the improvement of fertility level. Starting from the analysis of fertility theory, this paper selects the three dimensions of economy, time and employment, explores the internal mechanism of fiscal policy affecting fertility level, and sorts out the existing fiscal policies related to improving fertility level and their existing problems in China. Combined with the experience of foreign fertility policy implementation and the actual situation in China, it is recommended to improve China's fertility support policy from four aspects: policy targets, financial investment, development of childcare industry, and multiple subjects, so as to realize the new fiscal policy to promote the improvement of fertility level.

Objectification and ambiguity of body image in women with Polycystic Ovary Syndrome: A mixed-method study

BackgroundThe manifestations of Polycystic Ovary Syndrome (PCOS), including acne, hirsutism, obesity, uncertain fertility, etc., can make women anxious, worried, or even depressed with their appearance and body. However, little relevant research has been conducted in the Chinese context. This mixed-method study aimed to understand how women with PCOS in China perceive their bodies and to examine the association between body image and depression. MethodsFirst, 101 PCOS patients participated in a survey using the Body Surveillance subscale of the Objectified Body Consciousness Scale, the Short-form Mishel Uncertainty in Illness Scale, the Appearance Anxiety Scale, and the Beck Depression Inventory-II, which measured participants' self-objectification, illness ambiguity, appearance anxiety, and depression, respectively. Second, fifteen women joined face-to-face semi-structured in-depth interviews, investigating their illness ambiguity, objectified experience, and behaviors to pursue beauty. ResultsResults indicated a high level of self-objectification, illness ambiguity, appearance anxiety, and depression among women with PCOS in China and supported the significant associations among the outcomes. Qualitative findings presented a body image of the precarious body, indiscernible identity, and distraught mind. LimitationsA convenient sampling method was used. The generalization of the study results needs further validation. Future longitudinal studies are necessary to clarify the causal relationships among outcomes. ConclusionsThis study presented women's body image with PCOS and found the negative impact of body image on their depression levels. This study was of both theoretical and practical significance. Appropriate mind-body therapies were suggested for them.

Decisional Regret in Female Oncofertility Decision Making-An Integrative Narrative Review.

Simple SummaryWomen diagnosed with cancer at reproductive age often face potential impairments in fertility due to cancer treatments and complex and uncertain fertility decisions. The complexity of the decision-making process is often associated with psychological distress and a potential for long-term decisional regret around a decision made at diagnosis, which may have a negative impact on patients’ Quality of Life (QoL). Some factors have been associated with the experience of regret, such as patients’ perceived quality and satisfaction with the fertility counseling received, the decision to undergo fertility preservation procedures, desire for children and decisional regret. Awareness of these factors is of utmost importance to support and guide this population through their fertility decision-making process.It is well established that fertility is an important issue for young women with cancer at reproductive age, as many have not initiated or completed their parenthood goals when diagnosed. Because cancer treatments may impair fertility, women face fertility decisions that are often complex and surrounded by uncertainty. This may put patients at risk for psychological distress and the experience of regret regarding decisions made at diagnosis, which may be associated with a negative impact on women’s QoL. This narrative review addresses current knowledge about decisional regret regarding fertility preservation decisions in adult female cancer patients at reproductive age. Electronic searches were conducted on Pubmed database for articles published in English from 1 January 2000 to 1 July 2021 that assessed decisional regret following fertility decisions in young women diagnosed at childbearing age. Of the 96 articles identified, nine provided information on decisional regret regarding fertility decisions. Studies reported that, overall, decisional regret regarding oncofertility decisions was low. Factors associated with the experience of decisional regret were patients’ perceived quality and satisfaction with fertility counseling received, the decision to undergo fertility preservation, desire for children and decisional conflict. Health providers should be aware of the factors that are potentially modifiable and prone to improvement in order to reduce decisional regret. All efforts should be made to improve availability of and access to tailored high quality fertility counseling and fertility preservation. Given the growing evidence that decision aids (DAs) are effective in increasing knowledge and reducing decisional conflict and regret, their use in a routine and timely manner to complement fertility counseling is recommended.

Facing the unknown: uncertain fertility in young adult survivors of childhood cancer.

The purpose of this research was to describe the challenges young adult childhood cancer survivors (ACCS) experience of living with an unknown fertility status. In this qualitative study, we analyzed data from in-depth interviews with 25 ACCS (15 females, 10 males) using content-driven inductive thematic analysis and constant comparative techniques. Three themes provide insight into ACCS' experiences of living with an uncertain fertility status. (1) The marked psychological burden, which included fear, worry, anxiety, and sadness, was ubiquitous. (2) Romantic relationships were negatively affected and entailed fear of disappointing one's partner, the difficulty of discussing fertility issues, and shying away from romantic relationships. (3) Communication challenges with healthcare providers were apparent across the cancer trajectory, made worse by provider knowledge gaps and dismissal of fertility concerns. (4) Well-known gender stereotypes about pregnancy and childrearing were replicated, while the emotional and life impacts that uncertain fertility could exert on males were minimized. This study provides beginning insights into the experiences of young ACCS as they navigate an unknown fertility status and highlights existing gaps in fertility-related healthcare services. Uncertain fertility has implications for survivors' wellbeing that remain poorly addressed by the existing structure of cancer survivor and fertility services. Assessing and addressing the fertility-related needs of ACCS will continue to be a vital component of patient-centered care in the future, and research to develop comprehensive support, resources, and processes of care are vital to meet this priority need.

Perceptions of Pregnancy and Contraceptive Use: An In-Depth Study of Women in Los Angeles Methadone Clinics.

In 2016, 2.1 million people in the United States were estimated to have an opioid use disorder. Although the disorder can be safely and effectively treated with prescription methadone, treatment is potentially long term and may span women's peak childbearing ages. Little is known about women's reproductive health needs while on methadone. We interviewed 22 sexually active, nonpregnant women ages 21-39years at two Los Angeles methadone clinics in 2016. The interviews were transcribed and coded by four researchers using thematic and open coding techniques. One-half of the women were nulliparous and 17 were in stable, monogamous relationships with men. Women reported a range of feelings and perceptions about pregnancy, but nearly all wanted to delay pregnancy until discontinuing methadone. However, many women indicated limited interest in preventing pregnancy because of the relative stability of their relationships, fear of infertility, and low perceived risk of pregnancy. These factors influenced contraceptive use. Women described mixed feelings about pregnancy and many ultimately felt that an unplanned pregnancy would be acceptable in the context of their relationships and uncertain fertility. These findings provide context for previous quantitative findings that women in methadone treatment have higher rates of unintended pregnancy and lower rates of contraceptive use than the general population. Accurate information about pregnancy in the context of methadone treatment may help women to make proactive family planning decisions. Health care providers should discuss the guidelines for pregnancy on methadone and offer a range of options to help women achieve their reproductive goals.

Sexual Performance and Reproductive Health of Patients with an Ostomy: A Qualitative Content Analysis

This study was carried out to explore the sexual performance experiences of patients with an ostomy and their spouses. Determine the results of fertility in these patients is another goal of the study. Conventional content analysis approach with purposive sampling and unstructured interviews were utilized to collect data from 27 ostomy patients and ten of their spouses. They were selected from Iranian Ostomy Association in Tehran. Negative impact of treatments on the sexual health and trimmed sexual desire are main sexual problems experienced by patients with an ostomy. Some of them try to solve their problems while others deliberately neglect them. On the other hand their spouses either tolerate or accept these changes. Living with menopause suffering and the unknown status of fertility after ostomy are other significant problems of these patients. Sex life changes after ostomy because of different reasons. This alteration results in negative consequences in some cases. Patients and their spouses have their own approaches in order to adapt with the new conditions. Furthermore, status of uncertain fertility and how to deal with menopausal symptoms in these patients is notable.

Are Uncertain Fertility Intentions a Temporary or Long-term Outlook? Findings from a Panel Study

ObjectivesResearch suggests that a substantial minority of women are unsure if they want to have (more) children. This study examines whether this is a temporary or long-term outlook and which characteristics are associated with uncertainty about future childbearing intentions. MethodsPanel data from a national sample of 2,353 nonsterilized U.S. women aged 18 to 39 years were gathered at three points in time between 2012 and 2013. Women who indicated they were “not sure” if they wanted to have any (more) children were classified as uncertain. Random effects and fixed effects logistic regression were used to determine which baseline and time-varying characteristics were associated with fertility uncertainty and changes in uncertainty. ResultsAlthough 39% of the sample reported uncertain fertility intentions on at least one survey, only 9% were uncertain at all three. Characteristics associated with uncertainty included being ages 30 and older, having one or more children, perceiving one's partner to have uncertain childbearing intentions, and having a strong desire to avoid pregnancy. Characteristics associated with a decreased likelihood of uncertainty included relationship happiness and having a recent discussion about childbearing intentions with a health care provider. ConclusionsAt a given point in time, a substantial minority of women is uncertain whether they want to have more children, but it seems to be a temporary or transitional stage for most.

Young adult female cancer survivors' unmet information needs and reproductive concerns contribute to decisional conflict regarding posttreatment fertility preservation.

Many young adult female cancer survivors (YAFCS) are at risk of experiencing premature menopause. The current study characterized the posttreatment fertility information needs, reproductive concerns, and decisional conflict regarding future options for posttreatment fertility preservation (FP) among YAFCS. Participants completed a Web-based, anonymous survey between February and March 2015. The survey included investigator-designed questions of perceived information needs, the Reproductive Concerns After Cancer Scale, and the Decisional Conflict Scale. Analyses included Pearson correlation coefficients, independent-sample Student t tests, and multiple regression. There was a total of 346 participants with an average age of 29.9 years (SD = 4.1 years) who were 4.9 years from treatment (SD = 5.4 years [range, 0-27 years]). The main analyses focused on a subgroup of YAFCS with uncertain fertility status who had not previously undergone/attempted FP and either wanted future children or were unsure (179 women). Across fertility information topics, 43% to 62% of participants reported unmet information needs. The greatest reproductive concerns were related to fertility potential and the health of future offspring. The regression model controlled for a priori covariates including current age, age at treatment completion, income, relationship status, nulliparity, and prior fertility evaluation. Greater unmet information needs were found to be related to greater decisional conflict (β = .43; p<.001); greater reproductive concerns were associated at the trend level (β = .14, p = .08; F[8,118] = 6.42, p<.001). YAFCS with limited awareness or knowledge of their risk of experiencing premature menopause and FP options reported higher levels of decisional conflict regarding future FP. Posttreatment survivorship care should include comprehensive reproductive health counseling, including posttreatment FP options and family-building alternatives. Cancer 2016;122:2101-9. © 2016 American Cancer Society.

Mothering and Self-Othering: The Impact of Uncertain Reproductive Capability in Young Women After Hematological Malignancy

We explored the experiences of uncertain fertility, pregnancy, and motherhood in 12 young women treated for hematological malignancy during their reproductive years. It is demonstrated how, through interpretations of the women's own words, these women lived and coped with a sense of “otherness” in relation to their peers. The concept of otherness is described and discussed in relation to relevant existing literature and it is concluded that, regardless of their cancer history, young women's uncertainty in this context has a broad impact on their psychosocial health and requires sensitive and empathic information, discussion, and support.

Calamagrostis model revisited: Matrix calibration as a constraint maximization problem

A matrix model for age-stage-structured population dynamics of Calamagrostis canescens, a perennial grass species colonizing forest clear-cut areas, was calibrated before from a type of data called ‘identified individuals with unknown parents’ (Logofet, 2008) in order to estimate λ1, the dominant eigenvalue of the projection matrix. A number of methods were applied to tackle the ‘reproductive uncertainty’ in data, and the output variety contained λ1 both greater and less than 1 (Logofet, 2008), leaving the estimation uncertain. An ‘adaptation conjecture’ was then proposed that reduced the calibration to a nonlinear constraint maximization problem and provided for a satisfactory outcome.Two reasons have now caused revisiting. First, the maximization technique has been theoretically comprehended. In particular, an existence-uniqueness theorem has been proved that requires the maximizing solution to be reached at a vertex of the polyhedral of constrains. To facilitate searching for the solution in practice, I use the notion of potential-growth indicator and prove R0 and R1, the known indicators, to be certain linear functions of the uncertain fertility rates in a general class of projection matrix patterns. To solve a conjugate linear maximization problem under the same constraints as for λ1 is both theoretically and technically simpler, and this causes a practical benefit from the indication along with calculation.Second, the former uniform (non-specific) estimate of the upper bounds for the status-specific fertility rates has now conceded to the age-stage-specific estimates inferred from a special case study. These more sophisticated constraints produce respectively more accurate calibration, hence a more reliable estimation of λ1 as the growth potential inherent in the population in a certain environment at a given time.

Exploring the concept of uncertain fertility, reproduction and motherhood after cancer in young adult women

Exploring the concept of uncertain fertility, reproduction and motherhood after cancer in young adult women The topics of uncertainty in illness and infertility--as separate entities--are well covered and critiqued in the literature. Conversely, no research has been identified that specifically relates to the uncertain fertility, reproduction and motherhood challenges faced by young women after cancer. Therefore, there has been no opportunity to extend understanding, adequately acknowledge or effectively manage the needs of young women who may face unique reproductive uncertainties after cancer. The objective of this article is to provide a descriptive review of the literature and present what is currently known about uncertainty in the context of cancer and in relation to fertility, reproduction and motherhood. This article sets out the need for an increased research focus into this aspect of cancer survivorship to minimise the unique psychosocial challenges these women often face. Raising awareness and acknowledging the significance and impact of uncertain reproductive capacity on younger women's psychosocial health will aid cancer co-ordinators, nurses and other health professionals to formulate and deliver timely and appropriate education, management and support.

Poverty and procreation among women: An anthropologic study with implications for health care providers

In this article, select findings from a 5-year ethnographic study of homeless, pregnant women in Southern California pinpointed the contextual constraints, along with individual factors, that framed the women’s reproductive options and actions. The women had very little choice in the timing, the place, the partner, and the circumstances surrounding conception. Factors contributing to their becoming pregnant were the woman’s victimization, economic survival, lack of access to contraceptives, uncertain fertility, desire for intimacy, and hope for the future. Findings suggest that even if the women were able to establish reproductive goals and had the wherewithal to acquire and effectively use contraceptives, situational constraints (homelessness, pregnancy, poverty, contraception, fertility patterns) might still prevent their success.