Hope, burden or risk: a discourse analytic study of the construction and experience of fertility preservation in the context of cancer

Abstract

Objective: Infertility is a significant concern for people with cancer and fertility preservation is often recommended. However, uptake of preservation interventions remains low. In this study, we examined how people with cancer construct their subjectivity - their sense of self - in relation to decision making and processes of fertility preservation.

Design: Six-hundred and ninety-three women and 185 men completed a self-report survey; 61 women and 17 men participated in semi-structured interviews. Subject positions adopted in relation to constructions of fertility preservation in transcripts and open-ended survey responses were examined using thematic decomposition.

Results: Three main discursive themes were identified: 'Limited agency and choice, or resisting risk: not taking part in fertility preservation', 'Fertility preservation as a means to retain hope and control', and 'Fertility preservation as uncertain and distressing'.

Conclusion: It is important for health professionals to provide accurate information, acknowledge the complexity of fertility preservation and implications for 'liminal' survivorship where exclusion, uncertainty or unsuccessful interventions have occurred.

Keywords: Cancer; cancer survivorship; discourse analysis; fertility preservation; gender; infertility; liminality; subjectivity.