Women Undergoing Cancer Treatment Research Articles

Determinants of Contraception Among Women Undergoing Cancer Treatment: A Cross-Sectional Study from Zahedan, Iran

Objectives: This study investigates the prevalence of contraceptive use among women receiving cancer treatment in Zahedan, southeast Iran. We evaluated the role of various demographic and socio-cultural factors, fertility intentions, and care providers in contraceptive use. Methods: This cross-sectional study was conducted on 133 women of reproductive age receiving cancer treatment (chemotherapy or radiotherapy) in Zahedan. Patients referred to three medical centers in Zahedan from November 2019 to May 2020 were selected via the convenience sampling method and interviewed using a questionnaire. The data were analyzed in SPSS (version 18) using multinomial logistic regression. Results: It was found that 34.6% (N = 46) of women undergoing cancer treatment were at risk of unintended pregnancy, with 23.3% (N = 31) using the withdrawal method and 11.3% (N = 15) not using any form of contraception. Additionally, 37.0% (N = 49) of women reported inadequate knowledge about emergency contraception methods. Furthermore, 46.6% (N = 62) of women stated that the physician responsible for their cancer treatment had never discussed contraceptives with them. The highest prevalence of traditional contraceptive methods and non-use of contraception was observed among illiterate women, women with primary education, women living in polygamous families, women desiring more than four children, women who did not agree with their husbands on the contraceptive method, women who did not receive any physician consultation, and women living far from health centers. The multinomial logistic regression analysis revealed that the main predictors of contraception use were physician consultation about contraception (OR = 13.64, 95% CI: 2.13-87.32, P = .006) and couple agreement on the contraception method (OR = 9.91, 95% CI: 1.69-58.15, P = .011). Conclusions: Considering that, based on new population policies in Iran, access to free family planning (FP) services has ended and access to contraceptives is limited, women of reproductive age with illnesses—especially those with poor socioeconomic status, those living in polygamous families, and those in less developed regions—should be considered as a vulnerable group by the healthcare system. Furthermore, men should be included in consultation sessions with care providers to improve their participation in FP.

β-resorcylic acid released by Limosilactobacillus reuteri protects against cisplatin-induced ovarian toxicity and infertility

Chemotherapy-induced premature ovarian insufficiency (CIPOI) triggers gonadotoxicity in women undergoing cancer treatment, leading to loss of ovarian reserves and subfertility, with no effective therapies available. In our study, fecal microbiota transplantation in a cisplatin-induced POI mouse model reveals that a dysbiotic gut microbiome negatively impacts ovarian health in CIPOI. Multi-omics analyses show a significant decrease in Limosilactobacillus reuteri and its catabolite, β-resorcylic acid , in the CIPOI group in comparison to healthy controls. Supplementation with L.reuteri or β-RA mitigates cisplatin-induced hormonal disruptions, morphological damages, and reductions in follicular reserve. Most importantly, β-RA pre-treatment effectively preserves oocyte function, embryonic development, and fetus health, thereby protecting against chemotherapy-induced subfertility. Our results provide evidence that β-RA suppresses the nuclear accumulation of sex-determining region Y-box 7, which in turn reduces Bcl-2-associated X activation and inhibits granulosa cell apoptosis. These findings highlight the therapeutic potential of targeting the gut-ovary axis for fertility preservation in CIPOI.

Molecular Action of Tamoxifen in the Ovaries of Rats with Mammary Neoplasia

Tamoxifen (TAM) is a drug commonly used in patients with breast cancer. The anticancer effect of TAM occurs via its ability to antagonize estrogen-dependent growth of mammary epithelial cells. Previously, we demonstrated that TAM prevented the chemotherapy-induced loss of ovarian follicular reserves in both cancer-free rats and rats with cancer. Such follicular loss is a main cause of infertility in young women treated for cancer. The current study was undertaken to discover the molecules and intracellular pathways involved in the action of TAM in the ovaries of rats with mammary tumors. To meet this goal we used transcriptomic (RNA-Seq) and proteomic (2D-DIGE/MS) approaches. TAM inhibited the expression of genes and lncRNAs involved in ovarian steroidogenesis. Moreover, TAM altered the expression of genes related to primordial follicle activation or arrest. In addition, proteomic screening indicated the importance of basic metabolic processes in the ovarian actions of TAM. Although simple extrapolation of these data to humans is not possible, the results of this study emphasize the need to explore the ability of TAM to affect ovarian function in women undergoing cancer treatment.

Organization of psychosocial factors associated with worry about acquiring SARS-CoV-2 among women undergoing cancer treatment: an empirical network comparison approach

Objectives: Pandemic-induced anxiety can have adverse mental and somatic health consequences on cancer patients (CP). This study aimed to (1) explore the intricate relationships between worry related to potential SARS-CoV-2 infection, COVID-19 perception, sociodemographic factors, and the perceived effectiveness of lockdown measures and (2) investigate if these relationships differ between cancer patients and individuals without a history of cancer (IWHC). Methods: We conducted a cross-sectional quantitative study in France between December 1 and 14, 2020. Network analysis was employed on a sample of 1889 women, including 282 cancer patients and 1607 noncancer individuals. Results: Our findings indicate that CP were 20% more likely to express worry than IWHC. Anxiety is embedded within a complex network involving sociodemographic, cognitive, and emotional factors. The emotional components related to COVID-19 perception were found to play a crucial role. The networks for both groups were observed to be identical. Conclusions: Our study underscores the heightened vulnerability of cancer patients to pandemic-induced anxiety, emphasizing the crucial role of emotional components related to COVID-19 perception. The observed similarities in the anxiety network between cancer patients and those without a history of cancer suggest that universal approaches might be effective across groups. Implications: Utilizing the Causal Attitude Network Model, we propose potential methods for managing and reducing individual anxiety levels.

Informal and formal financial assistance to rural women during cancer treatment

IntroductionRural women with cancer are at heightened risk of financial toxicity. Financial assistance is an important, yet underexamined, aspect of how patients with cancer cope with financial toxicity. This study aims to examine the types of financial assistance rural women with cancer received during cancer treatment and how they described the impact of that assistance. Material and methodsUsing data from interviews with 36 rural women with cancer histories, this study used a qualitative descriptive design to explore the types of financial assistance participants received during cancer treatment. ResultsParticipants described two forms of financial assistance they received: informal and formal financial assistance. Informal financial assistance was provided by social networks and local communities and included cash support, community fundraisers, and in-kind donations. Formal financial assistance was provided by healthcare systems and charitable organizations and included resource navigation and cash grants. Both forms of financial assistance were helpful for many patients with cancer; however, not all participants who needed financial assistance received it. DiscussionInformal and formal financial assistance are significant forms of support for some rural women undergoing cancer treatment. However, such support is unequally distributed and may exacerbate existing inequalities. Financial assistance is not an adequate substitute for public policy that reduces the economic toll of cancer treatment on patients.

AVALIAÇÃO DE SINTOMAS CLIMATÉRICOS EM MULHERES JOVENS SUBMETIDAS À QUIMIOTERAPIA

ABSTRACT Objective: To describe the prevalence of climacteric symptoms in women undergoing cancer treatment and to analyze its relationship with the number of chemotherapy cycles. Methods: Cross-sectional study with 47 women undergoing chemotherapy in two cancer reference hospitals in São Luís, Maranhão, Brazil, between March 2019 and July 2020. A structured questionnaire was used containing sociodemographic variables and information on menstrual function and symptoms. Bivariate analysis and binary logistic regression were performed to assess the relationship between predictor variables and number of chemotherapy cycles. Results: Mean age was 31.71 years, and amenorrhea and hot flushes were the most frequent symptoms, however, unrelated to the number of chemotherapy cycles. There was no association between the presence of climacteric effects and the type of chemotherapy (p=0.15). Conclusion: The results reaffirmed that chemotherapy can cause climacteric symptoms, thus emphasizing the need for measures to alleviate symptoms in patients facing this problem.

Australian fertility preservation guidelines for people with cancer 2022: review and recommendations.

Australian fertility preservation guidelines for people with cancer 2022: review and recommendations.

Female fertility preservation in cancer patients.

Fertility preservation in cancer patients or oncofertility is a relatively new trend in modern medicine. In patients with unfulfilled reproductive plans, the possibility of starting a family is one of the key parameters of quality of life after overcoming a cancer. Guidelines have existed since 2013 and in 2020 the European Society of Human Reproduction and Embryology has also published a guideline, but the main problem of their application in clinical practice is the lack of information for both patients and, unfortunately, professionals, as well as the high cost of treatment. From 2022, health insurance companies in the Czech Republic partially cover the expenses for fertility preservation treatment for cancer patients. The possibilities of oncofertility are based, on the one hand, on improving the results of oncological treatment, on the other hand, on the development of reproductive technologies. Thanks to progress in treatment, up to 80% of pediatric oncology patients survive into adulthood, but chemotherapy, especially highly effective alkylating agents, is associated with a high risk of impaired fertility. This article overviewed9 modern global trends of fertility preservation in women undergoing cancer treatment based on an analysis of the English-language literature over the past 5 years.

Cancer treatment-specific medication beliefs among metastatic breast cancer patients: a qualitative study.

Over 168,000 women are living with metastatic breast cancer (MBC) in the USA. More efficacious treatments have lengthened overall survival, but these treatments often result in a myriad of symptoms and financial burden that may negatively impact perceptions of cancer treatment and medication-taking behavior. To explore cancer treatment-specific medication beliefs among women undergoing cancer treatment for MBC. A qualitative study was conducted using semi-structured interviews that were audio recorded and transcribed verbatim. A thematic analysis was conducted using ATLAS.ti 8.0 software. Inter-rater reliability was set at a threshold of 0.80. Participants were recruited from a National Cancer Institute-designated comprehensive care center. Eligibility included ≥18 years old, English speaking, confirmed MBC diagnosis, and able/willing to complete interviews via telephone or Zoom. Participants (n = 16) were largely Caucasian (86.7%) and non-Hispanic (93.3%). Mean age was 55.62 years. Three major themes were revealed, with corresponding subthemes: (1) positive cancer treatment-specific medication beliefs highlighting the benefit of treatment (relief of cancer-related symptoms and medication efficacy: delayed disease progression/extended survival); (2) negative cancer treatment-specific medication beliefs that caused concern for cancer treatment (medication symptoms, side effects and drug-drug interactions, financial toxicity, lack of guarantee medication would work); and (3) dialectical cancer treatment-specific medication beliefs indicating the benefits of cancer treatment outweigh the risks. Overall, participants noted that the benefits of cancer treatment outweighed the risks in the context of metastatic disease. Participants understood their prognosis and that they depended on their cancer treatment for survival. Oncology providers should continue to assess and address medication beliefs over the treatment trajectory and assist MBC patients with the decisional balance between the risk and benefit of continued cancer treatment.

Accuracy of Opportunistic Bone Mineral Density Assessment on Staging Computed Tomography for Gynaecological Cancers.

Background and Objectives: Women with gynecological cancers constitute a high-risk cohort for loss of bone density. International guidance stipulates women undergoing cancer treatments associated with bone loss should have a quantitative assessment of bone density. Access to Dual-energy X-ray Absorptiometry (DXA) is limited. This study aimed to assess the accuracy of opportunistic bone density measurement on staging computed tomography (CT) scans for gynaecological malignancies, in comparison to the gold standard DXA. Materials and Methods: Women with a staging CT scan of the abdomen and pelvis for a new diagnosis of gynecological cancer were recruited. DXA was performed within 6 weeks of treatment for gynaecological cancer. Lumbar bone density was measured by CT attenuation values, in Hounsfield units (HU), of the anterior trabecular region. Correlations between CT and DXA parameters were analysed. Receiver Operating Characteristic(ROC) curves for diagnosis of low bone density and osteoporosis were analysed. Results: Final cohort included 48 of 50 women recruited. There was good diagnostic accuracy for abnormal bone density and osteoporosis, with areas under the ROC curve at L1 of 0.77 (p = 0.002) and 0.80 (p = 0.020) respectively. CT-HU of 170–190 yielded sensitivities of 87–90%, positive predictive values of 75–84% and negative predictive values of 71–75% for the diagnosis of low bone mineral density. CT-HU of 90–110 yielded specificities of 85–93% for the diagnosis of osteoporosis. Moderate correlations were found between CT-HU and both DXA T-scores and diagnostic categories. Conclusions: This is the first study to assess the opportunistic application of CT in the assessment of bone health in women with gynaecological cancer, a cohort at high-risk of osteoporosis. The correlation between bone density assessment in CT-HU and DXA, and strong AUC values for the diagnosis of low bone density (0.77) and osteoporosis (0.80) support this pragmatic solution in resolving the care-gap in cancer treatment-induced bone loss, often associated with poor access to DXA.

Usage of a Web-Based Workplace and Symptom Self-Management Intervention Tool to Improve Work Ability for Breast Cancer Survivors.

This work aimed to evaluate the usage of a web-based intervention (WISE: Work ability Improvement through Symptom and Ergonomic strategies) developed to improve work ability for women recently diagnosed with breast cancer. Twenty-two women undergoing adjuvant treatment for breast cancer were provided access to WISE. This website includes content pages (e.g., information on ergonomics, symptom management, and other work-related resources) and worksheets (e.g., journals to track symptoms or goals). It could be personalized based on individual work activities and symptoms. Measures assessed at 3months included usage of the website and perceived usefulness. Thirteen of the 22 participants (60%) accessed WISE; 11 personalized their information. Content and worksheet pages had 97 and 79 visits, respectively. Most frequently visited pages were "setting goals" (i.e., prioritize and track symptoms; 45 visits) and "steps to creating your WISE plan" (i.e., incorporate symptom and ergonomic strategies; 16 visits). Median duration time was 11.05 (range 0.35-79.55) minutes. Usefulness of the content and worksheet pages assessed via a 7-point Likert scale (1 = strongly disagree, 7 = strongly agree) was 5.08 (SD = 1.59) and 4.26 (SD = 2.03), respectively. Participants were likely to recommend WISE to other women undergoing cancer treatment (mean = 6.11; SD = 1.05). The majority of participants personalized WISE work and symptom strategies. Overall, participants agreed that WISE content pages were useful and would recommend WISE for other breast cancer survivors. Results support that majority of breast cancer survivors, undergoing treatment with curative intent, accessed a web-based intervention that provided personalized information on workplace and symptom strategies.

Assessment of the emotional condition of women with cancer.

The incidence of malignant tumors in women is constantly rising. In 2018, 83 876 women were diagnosed with cancer, and 46 028 died from it. Since the 1980s, the incidence of malignant tumors in women aged 19-44 has been growing dynamically, and in middle-aged women (between 45 and 64 years old), nearly one in two deaths are due to cancer - exceeding mortality from cardiovascular disease. Upon diagnosis, the patient who may have been healthy so far faces emotions such as fear, anxiety, and sadness, caused by the awareness of having a progressive disease. Therefore, a somatic disease may trigger the development of a psychological disorder. The purpose of the present paper was to assess the emotional condition of women with cancer. Our survey included 100 patients hospitalized at the radiotherapy, gynecologic oncology, and breast units of the Lower Silesian Cancer Center in Wrocław, Poland, between August and November, 2017. We used the Mini-Mental State Examination (MMSE), the Zung Self-Rating Depression Scale (ZSDS), the Hospital Anxiety and Depression Scale (HADS-M), and the C-HOBIC readiness for discharge questionnaire. The mean patient age was 58.91 years (SD=13.74), the youngest patient was 23 years old and the oldest was 86 years old. More severe anxiety and depression symptoms were negatively associated with readiness for discharge. Among the women studied, widows and divorcees had higher levels of depression. Women who had completed primary education were more likely to suffer from anxiety than those with high school education. Duration of illness did not significantly affect the emotional condition of women undergoing cancer treatment. In the group of female cancer patients studied, more than half had no depressive symptoms. Emotional disorders negatively affect patients' readiness for discharge. Anxiety is significantly associated with education level, and depression - with the patients' marital status.

The Benefit of a Couple-Based Intervention Among Women in Active Cancer Treatment on Sexual Concerns: A Quasi-Experimental Study.

Sexuality-related problems are common in women with cancer, threatening their sexual well-being and intimate relationships. Evidence-based interventions addressing the full range of sexual concerns among women in active cancer treatment are scarce. The aim of this study was to evaluate the benefits of a novel couple-based intervention focusing on sexual concerns among women undergoing cancer treatment, including a subgroup of women with breast cancer. A secondary aim was to assess changes in illness intrusiveness in daily life. A quasi-experimental single-group pre-post follow-up design was used. The study was initially planned as a randomized controlled trial with waitlist control group receiving delayed intervention. However, substantial differences were observed in clinical and demographic variables between the treatment group and control group, resulting in using a single-group pre-post follow-up design. The intervention consists of 3 advanced nurse-led, face-to-face couple-based sessions supported by access to web-based information. Women in active cancer treatment participated in the study (n = 60) together with their partners (n = 60). The main results showed significant differences between time points in the outcome measures for concerns related to the sexual adverse effects of cancer treatment (T1 vs T2, and T2 vs T3), sexual concerns related to the women's partners (T1 vs T2), and for concerns related to communication with healthcare providers about sexuality-related issues (T1 vs T2). No significant changes were found over time with respect to illness interference on the intimacy or instrumental subscales. The results demonstrated that the approach of 3 couple-based therapeutic conversations is beneficial in reducing sexual concerns among women in active cancer treatment. Advanced nurse practitioners can develop and offer brief psychoeducational support that is helpful in reducing sexual concerns among women in active cancer treatment.

55. Assessing Reproductive Health Among Adolescents and Young Adults Undergoing Cancer Treatment: A Pilot Study

<h3>Background</h3> Adolescent and young adult (AYA) women undergoing cancer treatment face unique reproductive health risks. This study sought to determine sexual health practices and communication with oncology providers among female AYA cancer patients. <h3>Methods</h3> After IRB approval, actively treated cancer patients were offered participation if they were female, age 15-39 years, and English-speaking. Excluded were pregnant patients and those with a history of hysterectomy or removal of both ovaries and/or fallopian tubes. Participants completed an online survey regarding demographics, cancer history, sexual history, and communication with their oncologists. The main outcome measures assessed included rates of contraception, condom use, and sexual activity. Communications about sexual health with oncologists was also assessed. <h3>Results</h3> The 8 participants were a median of 24 years (range 16-37) with a history of breast cancer (50%), hematologic malignancies (25%), and other malignancies (25%). Treatment exposures in patients included chemotherapy (75%), radiation (62.5%), and surgery (50%); no one received only surgery. Lifetime history of heterosexual vaginal intercourse was reported in 62% of patients and other sexual activity such as oral or anal sex in 75%. Since cancer diagnosis, 50% reported having heterosexual vaginal intercourse, of which 50% reported using any contraception at last intercourse and no one reported using condoms. Overall, 62.5% had never discussed pregnancy prevention with their oncologists, and none recalled discussing STIs. Only 37.5% stated that they were told that sexual health discussions were confidential. <h3>Conclusions</h3> AYA women undergoing cancer treatment face unique sexual and reproductive health risks. This study demonstrates that there may a sizeable portion of these patients not taking precautions against pregnancy or STIs, and that there may be a need to increase discussions and counseling about these topics. Further research is needed to determine whether these findings persist in a broader population of AYA female cancer patients.

Occurrence of oral mucositis in women during oncological treatment of breast cancer in the Brazilian Northeast

Objective: To describe the occurrence of oral mucositis (OM) in women undergoing cancer treatment for breast cancer (BC). Methods: This is a retrospective, quantitative, and analytical study in medical records of women diagnosed with BC in an oncology service. Clinical data were collected regarding the occurrence and severity of OM according to the World Health Organization criteria and the cancer treatment experienced by the participants. Results: 196 women were included. Of these, 97 (49.5%) developed OM, 43.4% of which were grade 1 or 2 (low or moderate). The occurrence was higher in white women (OR 1.93; 95% CI 1.04 - 3.57; p = 0.035), with metastatic breast cancer (OR 5.46; 95% CI 1.79 - 16.64; p = 0.002) and who experienced taxane agents at some point during chemotherapy (OR 2.26; 95% CI 1.12 - 4.56; p = 0.02). The mean severity of OM in the entire sample was 0.8 ± 1.0, and in the affected women was 1.7 ± 0.7. The difference in the severity of OM by the variables was observed only among women with grade 2 and grade 3 fatigue (p = 0.03). Conclusions: OM is a common mucocutaneous toxicity in women with BC. Despite the low severity observed, care for women with BC undergoing cancer treatment must consider the possible risks and complications associated with OM, adopting strategies to prevent, monitor, and treat them.

Contraception Counseling and Use Among Adolescent and Young Adult Female Patients Undergoing Cancer Treatment: A Retrospective Analysis.

Study ObjectiveAdolescent and young adult (AYA) women undergoing cancer treatment face unique reproductive health risks. This study aimed to assess the prevalence of sexual health counseling and contraception use in the oncology setting, and to identify patient factors associated with these outcomes.DesignRetrospective chart review.SettingYale New Haven Hospital from 2013 to 2018.ParticipantsFemale patients 15-25 years of age receiving cancer treatment, excluding those treated with surgery only.InterventionsNone.Main Outcome MeasuresOutcomes of documented sexual health counseling and contraception use were assessed for frequency. Associations between patient factors and these outcomes were assessed using Pearson χ2 and Fisher exact tests, and multivariate logistic regression was used to identify predictors of these outcomes.ResultsIn this cohort (n = 157), the median age was 20.5 years, and the most common diagnoses were hematologic (40.8%) and thyroid (31.2%) malignancies. Of the patients, 33.1% were documented as receiving sexual health counseling, and 48.4% used contraception. Younger patients (15-20 years of age) were less likely to receive counseling (OR 0.31, 95% CI 0.14-0.70, P = .005). Receiving counseling (OR 3.36, 95% CI 1.35-8.34, P = .009) and sexual activity (OR 4.18, 95% CI 1.80-9.68, P = .001) were significantly associated with contraception use.ConclusionsSexual health counseling was documented infrequently during oncologic care for AYA women, especially for younger patients. However, such conversations were associated with a higher likelihood of contraception use. There is a need to improve rates of counseling in this high-risk setting, in which adolescents may be more vulnerable with regard to sexual health.

Contraception Counseling and Use Among Adolescent and Young Adult Women Undergoing Cancer Treatment [11I

INTRODUCTION: Adolescent and young adult women undergoing cancer treatment face unique reproductive health risks. The objectives of this study were to assess the prevalence of pregnancy prevention counseling and contraception use in the oncology setting, and to identify patient factors associated with these outcomes. METHODS: After institutional review board approval, a retrospective chart review was conducted of female patients ages 15-25 receiving cancer treatment, excluding those treated with only surgery, at Yale New Haven Hospital from 2013-2018. Univariate and multivariate logistic regression were used to assess the relationship between patient variables and the outcomes of counseling and contraception use. RESULTS: 157 patients were included in this analysis; the median age was 20, and the most common diagnoses were hematologic (40.8%) and thyroid (31.2%) malignancies. Treatments received included various combinations of surgery, chemotherapy, radiation, hormone therapy, targeted or biologic agents, and bone marrow transplant. 33.1% were documented as receiving reproductive health counseling and 48.4% used contraception. Younger patients (ages 15-20) were less likely to receive counseling (OR 0.31, 95% CI 0.14-0.70, P=.005). Receiving counseling (OR 3.36, 95% CI 1.35-8.34, P=.009) and sexual activity (OR 4.18, 95% CI 1.80-9.68, P=.001) were significantly associated with contraception use. CONCLUSION: Reproductive health counseling was documented infrequently during oncologic care for adolescent and young adult women, especially for younger patients. However, such conversations were associated with a higher likelihood of contraception use. There is a clear need to improve rates of counseling in this high-risk setting, especially with adolescents who may be more vulnerable when it comes to reproductive health.

Sphingosine-1-phosphate (S1P) in ovarian physiology and disease

Sphingosine-1-phoshate (S1P) is a membrane sphingolipid involved in several physiological processes, including cell proliferation, tissue growth, cell survival and migration, inflammation, vasculogenesis, and angiogenesis. Herein, we review the most critical effects of S1P on ovarian function, including its physiological and pathophysiological effects. Based on the available evidence, S1P plays an important role in ovarian physiology, participating as an essential stimulator of follicular development in both the preantral and antral phases, as well as in ovulation and corpus luteum development. Moreover, S1P may be a good cytoprotective agent against cancer treatment side-effects (chemotherapy with or without radiation therapy). In the future, this compound may be given for fertility preservation to women undergoing cancer treatment. However, further studies are required to confirm its efficacy in ovarian protection and also its safety in terms of cancer prognosis, given the biological action of the compound. Under- or over-production of S1P may be related to ovarian pathologies.

A review of factors affecting patient fertility preservation discussions & decision-making from the perspectives of patients and providers.

Women undergoing cancer treatments and their healthcare providers encounter challenges in fertility preservation (FP) discussions and decision-making. A systematic review of qualitative research was conducted to gain in-depth understanding of factors influencing FP discussions and decision-making. Major bibliographic databases and grey literature in English from 1994 to 2016 were searched for qualitative research exploring patient/provider perspectives on barriers and facilitators to FP decision-making. Two researchers screened article titles, abstracts and full-texts. Verbatim data on research questions, study methodology, participants, findings and discussions of findings were extracted. Quality assessment and thematic analysis were conducted. The search yielded 74 studies dating from 2007 onwards; 29 met the inclusion criteria. Analysis revealed three types of barriers: (a) FP knowledge, skills and information deficits contributed to discomfort for providers and discontent for patients; (b) psychosocial factors and clinical issues influenced providers' practices around FP discussions and patients' decision-making; and (c) material, social and structural factors (e.g., lack of resources and accessibility) posed challenges to FP discussions. Potential facilitators to FP discussions and decision-making were also identified. A discussion of ways to improve physician's knowledge and facilitate women's decision-making and access to FP is presented, along with areas for policy development and further research.

Bio-inspired solute enables preservation of human oocytes using minimum volume vitrification.

The ability to cryopreserve human oocytes has significant potential for fertility preservation. Current cryopreservation methods still suffer from the use of conventional cryoprotectants, such as dimethyl sulphoxide (DMSO), causing loss of viability and function. Such injuries result from the toxicity and high concentration of cryoprotectants, as well as mechanical damage of cells due to ice crystal formation during the cooling and rewarming processes. Here we report the preservation of human oocytes following vitrification using an innovative bio-inspired cryoprotectant integrated with a minimum volume vitrification approach. The results demonstrate that the recovered human oocytes maintained viability following vitrification and rewarming. Moreover, when this approach was used to vitrify mouse oocytes, the recovered oocytes preserved their viability and function following vitrification and rewarming. This bio-inspired approach substitutes DMSO, a well-known toxic cryoprotectant, with ectoine, a non-toxic naturally occurring solute. The bio-inspired vitrification approach has the potential to improve fertility preservation for women undergoing cancer treatment and endangered mammal species.