Navigating infertility treatment in Canada : a qualitative study of the experiences of female adult survivors of childhood cancer

Background: Cancer and cancer treatments during childhood can affect fertility and reproduction during adulthood. Some female adult childhood cancer survivors (ACCS) who experience fertility-related issues and/or infertility might seek treatment, including artificial reproductive technologies (ART), which may help them to conceive. However, the limited evidence of ACCS’s experience of navigating infertility treatments prevents the designing and tailoring of healthcare services to the unique needs of this growing population, particularly in the Canadian public healthcare context. The study purpose was to understand the challenges female ACCS experience while navigating infertility treatments with the intent of using what was learned to inform clinical practice. Research Methods: In this qualitative, interpretive description study, semi-structured interviews were conducted with six female ACCS (aged 25 - 39 years, completed cancer treatment a mean of 23 years prior, and spent a mean of 2.5 years trying to conceive) who experienced infertility and ART. Transcribed interview data were analyzed using inductive coding, constant comparative techniques and writing of memos and analytic notes. Findings: Prominent challenges described by female ACCS included: 1) feeling a sense of shock when impaired fertility became apparent, 2) experiencing loss and grief with impaired fertility and unsuccessful fertility treatments, 3) enduring an impaired self-identity, particularly in relation to womanhood and femininity, triggered by impaired fertility,4) navigating a healthcare system where fertility-related challenges are not always considered. ACCS’ recommendations and aspirations for an improved healthcare system focused on funding, accessibility of ART in Canada, adoption policies and the lack of infertility-specific information and psychosocial supports. Discussion: The findings from this study suggest that for some ACCS, there can be significant loss and grief and impaired self-identity associated with infertility, pregnancy loss, ART and further efforts to become a parent. Further research to expand upon insights from this study is necessary to lay the foundation for re-envisioning Canadian healthcare that addresses the complexity of infertility treatment for cancer survivors.Applied Science, Faculty ofNursing, School ofGraduat