Fertility-related knowledge and childbearing attitudes among female survivors of hematopoietic stem cell transplantation: a cross-sectional study.

PURPOSE: Hematopoietic stem cell transplantation (HSCT) causes severe gonadotoxicity. This study assessed fertility-related knowledge, childbearing attitudes, and their sociodemographic determinants among female HSCT survivors.

METHODS

This cross-sectional study evaluated 209 women (≥ 1 year post-HSCT) at Iran's largest referral center. Data were collected using sociodemographic profiles, a researcher-developed Fertility Knowledge Questionnaire, and the Attitude Toward Fertility and Childbearing Scale. Multivariable linear regression identified independent predictors.

RESULTS

Participants' mean age was 34.72 ± 9.05 years. Fertility knowledge was poor (mean score: 4.56 ± 1.92 out of 10), with critical deficits regarding post-transplant pregnancy timing (92.3% incorrect) and treatment-related risks (94.7% incorrect). Conversely, childbearing attitudes were relatively positive (mean score: 63.25 ± 10.73), and 47.4% desired future children. A significant inverse correlation emerged between knowledge and attitude scores (r = - 0.334, p < 0.01). In multivariable analyses, older age, Master's education, divorce, and insurance predicted higher knowledge (R2 = 0.46). Younger age, fewer children, and superior economic status predicted more positive attitudes (R2 = 0.31).

CONCLUSIONS

Female HSCT survivors exhibit critical fertility knowledge deficits despite positive parenthood attitudes. The inverse knowledge-attitude correlation suggests that enhanced risk awareness might temper reproductive optimism.

IMPLICATIONS FOR CANCER SURVIVORS: These findings necessitate incorporating structured, multidisciplinary, and psychologically informed fertility counseling into routine HSCT survivorship care, ideally initiated prior to conditioning regimens, to facilitate informed reproductive decision-making.