Parental Attitudes Toward Fertility Preservation in Female Adolescent Cancer Patients in Lebanon

Motherhood, Fairness, and Flourishing: Widening Reproductive Choices in Saudi Arabia

“…In a study in Lebanon in 2019, a country with a significant Muslim population, researchers reported that religiously observant parents of pediatric cancer patients worried that oocyte retrieval might jeopardize their daughters' hymens. 79 Another article looking at cryopreservation in Egypt found similar concerns regarding hymen loss, and posited that undergoing any gynecological procedure may greatly affect a woman's chances of marriage in some communities. 80 In Saudi Arabia, similarly, culturally pervasive concerns sometimes impact access to and delivery of care, with some practitioners and researchers wary of performing pelvic exams due to their cultural sensitivity and potential social and legal implications.…”

Communication and ethical considerations for fertility preservation for patients with childhood, adolescent, and young adult cancer: recommendations from the PanCareLIFE Consortium and the International Late Effects of Childhood Cancer Guideline Harmonization Group

“…Evidence concerning barriers to communication of infertility risk and fertility preservation showed varying levels of evidence. In regard to patient and family perspectives, there is moderate-quality evidence that poor physical status and a highly stressed emotional status of patients; 25,[41][42][43][44][45][46][47] time constraints regarding delaying treatment; 25,[45][46][47][48]55 costs; 43,45,53 absence of interest; 44,45,48 experimental nature of the procedure for fertility preservation with the associated risks; 25,42,45,46,48,53,54 highly stressed emotional status of parents; 44,54,56 absence of parental or medical recommendation; 49,50 absence of patient self-efficacy for banking; 50,51 absence of experience with, taboo regarding, and embarrassing feelings with masturbation; 25,49 cultural and religious beliefs; 41,45 poor success rate of the procedure for fertility preservation procedure; 45,46 and young age at diagnosis 40,52 • Some parents of male patients diagnosed at younger than 18 years want to control whether physicians discuss sperm banking with their child (very low-quality ...…”

“…• Patient with poor emotional or physical status, or both (moderate-quality evidence) 25,41-47 • Absence of interest (moderate-quality evidence) 44,45,48 • Scarcity of experience with, taboo related to, and embarrassing feelings with masturbation (moderate-quality evidence) 25,49 • Absence of patient self-efficacy for banking (moderatequality evidence) 50,51 * • Young age at diagnosis (moderate-quality evidence) 40,52 • Insufficient information (low-quality evidence) 43 Procedure-related barriers: • Experimental nature of the procedure for fertility preservation with the associated risks or complications (moderate-quality evidence) 25,42,45,46,48,53,54 • Time constraints regarding delaying treatment (moderatequality evidence) 25,[45][46][47][48]55 • Costs (moderate-quality evidence) 43,45,53 • Poor success rate of the procedure for fertility preservation (moderate-quality evidence) 45,46 Parent-related barriers: • Parents have a highly stressed emotional status (moderatequality evidence) 44,54,56 • Absence of parental or medical team recommendation, or both (moderate-quality evidence) 49,50 • Cultural or religious beliefs (moderate-quality evidence) 41,45 • Sensitive nature of the conversation about fertility preservation (parent-reported barrier; low-quality evidence) 24 • Absence of parental self-efficacy (low-quality evidence) 49 Barriers related to health-care providers and institutions: • Absence of specific consultation by fertility specialist (low-quality evidence) 57 • Difficulty in finding proper facilities (low-quality evidence) 45 • Adult treatment centre versus non-adult treatment centre (low-quality evidence)…”

“…to discussing treatment effects on fertility and options for fertility preservation. Additionally, low-quality evidence exists that the sensitive nature of conversations about fertility preservation, 24 absence of parental self-efficacy, 49 absence of specific fertility specialist consul tation, 57 difficulty in finding proper facilities, 45 and insufficient information 43 are also barriers for the communication of fertility preservation. Similarly, health-care providers experience barriers to counselling about infertility risk and fertility preservation that are related to related to patients, parents, health-care providers and institutions, and procedures (low-quality to moderate-quality evidence).…”

“…On the basis of the evidence indicating the patients' scarcity of information or interest, [43][44][45]48,49,53 a patient's prognosis 25,31,32,[41][42][43][44][45][46][47][48]52,53,[58][59][60][61][62][63] and age, 31,40,52,58,63 and the experimental nature of the fertility preservation pro cedures and associated risks, 25,42,45,46,48,[52][53][54]59,61 we strongly recommend that health-care providers deliver clear, comprehensive, and age-appropriate information, and that they provide up-to-date written or online educational resources, or both, to patients and their families in appropriate languages and health-literacy levels (very low-quality to (Panel 1 continued from previous page)…”