The experience of fertility preservation decision-making in hematopoietic stem cell transplantation patients: a qualitative study.

BACKGROUND

Fertility preservation represents a significant challenge for patients undergoing hematopoietic stem cell transplantation (HSCT); however, their decision-making experiences remain poorly understood. This study aimed to explore the decision-making experiences of HSCT patients regarding fertility preservation and the factors influencing these decisions.

METHODS

A qualitative study was conducted using semi-structured interviews with 12 reproductive-aged patients at a tertiary hematology hospital in China. The interview data were analyzed using thematic analysis.

RESULTS

Three core themes were identified: (1) survival as the absolute prerequisite-patients uniformly prioritized life-saving treatment over fertility preservation, particularly when facing critical illness; (2) systemic resource constraints-limited information accessibility, financial burden, and healthcare system barriers significantly hindered decision-making; and (3) gender-and parenthood-stage-driven motivations-female patients considered both reproductive and endocrine health, while male patients focused predominantly on biological continuity, with decisions varying based on family completion status.

CONCLUSION

Fertility preservation decisions in HSCT patients are complex and multidimensional, shaped by an interplay among survival needs, resource limitations, and sociodemographic factors. Developing structured clinical pathways with tailored counseling is essential to support patient-centered decision-making in this vulnerable population.