Psycho-Oncology Psycho-Oncology 20: 1044–1052 (2011) Published online 2 September 2010 in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/pon.1826 Facilitating reproductive choices: the impact of health services on the experiences of young women with breast cancer Rebecca J. Lee 1 , Ann Wakefield 2 , Sharon Foy 1 , Sacha J. Howell 1 , Andrew M. Wardley 1 and Anne C. Armstrong 1Ã 1 Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK 2 The School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK Abstract Objective: Chemotherapy and hormone treatments carry significant implications on the fertility of young women with breast cancer. Increasingly, nulliparous women experience fertility dilemmas due to rising survival rates and pregnancy delay. This qualitative study investigated women’s responses to being told that treatments affected their fertility and how their interactions with health services impacted on their experiences. Methods: Twenty-four women under 40 years participated in three focus groups using a flexible interview structure. Data were analysed using content analysis and participants subsequently member checked the themes generated. Results: The priority for most women was survival, although women without children were more willing to take risks. Many women felt that pregnancy after breast cancer and methods of egg harvesting carried a significant risk to survival and fears appeared to be increased by conflicting advice from health professionals. Overall, the women felt the cancer, its treatment options and the health service itself had each robbed them of choice. Hence, with hindsight, many said they would have welcomed an open and honest discussion with a fertility expert to maximise their options. Conclusions: Young women with breast cancer face complex decisions regarding their fertility and treatment options. Survival remains the priority for the majority of women. Although there is a paucity of evidence concerning many fertility issues, it is essential that available options and any potential risks are discussed in a coherent, objective fashion. Early referral to specialist fertility services that provide clear, cohesive advice can aid informed decision making. Copyright r 2010 John Wiley & Sons, Ltd. Keywords: breast cancer; oncology; fertility; services Background Breast cancer is the most common malignancy affecting women of reproductive age [1]. It is associated with a poorer prognosis in young women [2,3]; therefore, they are more likely to be offered adjuvant chemotherapy to reduce their risk of death by 25–30% [4]. As breast cancer survival rates increase, quality of life issues such as fertility become increasingly important. More women are now delaying childbirth and with the average age of childbirth in the UK in 2007 at 29.5 years, the impact of breast cancer treatments on fertility are of particular significance [5]. Both the National Institute of Clinical Excellence and the Royal College of Physicians have published recommenda- tions that all patients of reproductive age should be offered, if time allows, oocyte or embryo cryo- preservation [6,7]. Despite this, there is still a lack of knowledge surrounding fertility issues and services available for young women with breast cancer. A fertility service was set up in the North West of England in 2008, offering women an urgent consultation with a fertility expert and possible fertility preservation before commencing chemo- therapy. Its introduction provided the opportunity to evaluate what users wanted and how it affected their fertility choices and cancer experience. The study, conducted in March 2009, examined wo- men’s experiences of health services offered and the extent to which treatment options influenced their thoughts and feelings at diagnosis, during treat- ment, subsequent follow up and beyond. Chemotherapy has been shown to induce pre- mature ovarian failure in numerous studies [4,8,9]. The risk of failure depends on the regimen, dose * Correspondence to: Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK. E-mail: Anne.Armstrong@ christie.nhs.uk Received: 10 December 2009 Revised: 5 July 2010 Accepted: 6 July 2010 Copyright r 2010 John Wiley & Sons, Ltd.