Health expectations : an international journal of public participation in health care and health policy · 2026
Negotiating Reproductive Identity After Cancer: A Qualitative Systematic Review of Female Survivors' Post-Treatment Fertility Experiences.
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Wang Yijun, Turnbull Margo Louise, Oktavianus Jeffry, Wu Xiaoyan I
Аннотация
BACKGROUND: Fertility concerns are common among female cancer survivors and are shaped by sociocultural influences that extend beyond biomedical outcomes. Previous systematic reviews have consolidated evidence on fertility-related distress but have tended to operate within clinical or descriptive frameworks. Although identity-related findings have emerged in existing reviews, they received limited conceptual attention.
OBJECTIVE: Guided by the concept of reproductive identity, this review systematically synthesises qualitative research on how female cancer survivors experience, negotiate, and reconstruct their reproductive identities within the broader context of post-cancer survivorship.
METHODS: A systematic search was conducted in eight databases for qualitative studies published in English and Chinese between January 2010 and February 2026. The review followed PRISMA guidelines and was prospectively registered in PROSPERO (CRD42024604353). Data were synthesised using thematic synthesis, with coding conducted inductively before the reproductive identity framework was applied as an interpretive lens.
RESULTS: Thirty studies met the inclusion criteria. Three analytical themes were identified: (1) macro-level discourses and structures shape reproductive identity-fertility is positioned as secondary to survival within cancer care and constrained by sociocultural motherhood narratives; (2) micro-level relational dynamics and internal processes shape reproductive identity-fertility concerns are navigated within intimate relationships and through ongoing (re)working of reproductive selfhood; and (3) lived experience informs the reimagining of macro-level care-participants' experiences of structural constraints generated insight into how care systems could better support reproductive identity across survivorship.
CONCLUSION: The findings of this review highlight that post-cancer fertility is a dynamic process of identity negotiation shaped by the interplay between macro-level discourses and micro-level relational and internal processes. This reinforces the importance of embedding reproductive identity literacy into survivorship care through proactive, clinician-initiated fertility conversations and coordinated referral pathways that extend beyond the treatment phase.
PATIENT AND PUBLIC CONTRIBUTION: Patient and public involvement were not formally incorporated into this review. However, the first author is a female cancer survivor with lived experience of fertility preservation, whose patient perspective contributed to the development of the research, the interpretation of findings and the framing of implications for survivorship care.
OBJECTIVE: Guided by the concept of reproductive identity, this review systematically synthesises qualitative research on how female cancer survivors experience, negotiate, and reconstruct their reproductive identities within the broader context of post-cancer survivorship.
METHODS: A systematic search was conducted in eight databases for qualitative studies published in English and Chinese between January 2010 and February 2026. The review followed PRISMA guidelines and was prospectively registered in PROSPERO (CRD42024604353). Data were synthesised using thematic synthesis, with coding conducted inductively before the reproductive identity framework was applied as an interpretive lens.
RESULTS: Thirty studies met the inclusion criteria. Three analytical themes were identified: (1) macro-level discourses and structures shape reproductive identity-fertility is positioned as secondary to survival within cancer care and constrained by sociocultural motherhood narratives; (2) micro-level relational dynamics and internal processes shape reproductive identity-fertility concerns are navigated within intimate relationships and through ongoing (re)working of reproductive selfhood; and (3) lived experience informs the reimagining of macro-level care-participants' experiences of structural constraints generated insight into how care systems could better support reproductive identity across survivorship.
CONCLUSION: The findings of this review highlight that post-cancer fertility is a dynamic process of identity negotiation shaped by the interplay between macro-level discourses and micro-level relational and internal processes. This reinforces the importance of embedding reproductive identity literacy into survivorship care through proactive, clinician-initiated fertility conversations and coordinated referral pathways that extend beyond the treatment phase.
PATIENT AND PUBLIC CONTRIBUTION: Patient and public involvement were not formally incorporated into this review. However, the first author is a female cancer survivor with lived experience of fertility preservation, whose patient perspective contributed to the development of the research, the interpretation of findings and the framing of implications for survivorship care.