Reproductive Concerns and Awareness of Oncofertility Preservation among Female Cancer Patients: Implications for Sustainability

Reproductive Concerns and Awareness of Oncofertility Preservation among Female Cancer Patients: Implications for Sustainability | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Reproductive Concerns and Awareness of Oncofertility Preservation among Female Cancer Patients: Implications for Sustainability Aya M. Abdelhafez, Heba M. Mohamed, Alaa El-Din Mahmoud Ismail, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9003906/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Background One of the greatest concerns for cancer patients of reproductive age is fertility. Numerous studies have demonstrated that patients with cancer lack regular access to fertility preservation information options. This study aimed to evaluate awareness of reproductive concerns for infertility preservation among female cancer patients. Methods A case series study was conducted between March and August 2024 at the gynecological oncology unit in collaboration with the assisted reproductive technology unit at Woman Health Hospital, Assiut University, Egypt. A purposive sample of 20 women aged 16–40 years with newly diagnosed early-stage cancer who had not yet initiated treatment and received fertility counseling was recruited. Data were collected through structured face‒to-face interviews via questionnaires covering personal, obstetrical, reproductive, and cancer-related characteristics, in addition to the Infertility Knowledge Questionnaire, the Reproductive Concerns after Cancer Scale, the Fertility Intention Scale, and the Decisional Conflict Scale. Associations between study variables and participants’ characteristics were examined via appropriate statistical analyses. Results Most women with cancer had poor knowledge about fertility preservation, high reproductive concerns, high fertility intentions and low decisional conflict. There was a highly significant difference between the levels of education, infertility knowledge and infertility intentions (p values <0.001 and <0.041, respectively). Conclusion Mostfemale cancer patients reported high reproductive concerns and strong fertility intentions despite limited knowledge about infertility and fertility preservation. Education level and selected obstetrical factors were significantly associated with infertility knowledge, fertility intentions, and reproductive concerns. Oncofertility Fertility preservation Reproductive concerns Infertility knowledge Fertility intention Decisional conflict Assisted reproductive technology SDG 3.7 Introduction Women’s reproductive health is a global priority reflected in Sustainable development goal 3, which calls for equitable access to high-quality reproductive health services and reliable information by 2030 ( 1 , 2 ). SDG 3.7 further emphasizes the need to integrate sexual and reproductive health counseling into routine care, a goal particularly relevant for women at risk of treatment-related infertility ( 3 ). As cancer survival improves, fertility preservation has become an essential dimension of survivorship, supporting long-term well-being and quality of life for female cancer patients ( 4 ). For women diagnosed during their reproductive years, fertility concerns are common and often emotionally distressing. Evidence shows that maintaining the possibility of future childbearing supports psychological adjustment, whereas anticipated infertility contributes to worry and reduced well-being. Despite international recommendations for early fertility counseling, gaps in communication and limited access to fertility information remain ( 5 – 7 ). Nurses play a central role in supporting decision-making by offering education, emotional support, and coordination across oncology and fertility services ( 8 ). Strengthening this role is important to ensure that women receive consistent and timely guidance. Understanding women’s awareness of reproductive risks and available preservation options is therefore essential. This study aims to explore female cancer patients’ awareness of reproductive concerns related to oncofertility preservation. Methods Study design and setting A case series study design was carried out from March to the end of August 2024 at the gynecological oncology unit in collaboration with the assisted reproductive technology unit at Woman Health Hospital, Assiut University, Egypt. This hospital is a large university teaching hospital that receives patients from all over Upper Egypt. Participants A purposive sample of twenty women between the ages of 16 and 40 years who had been recently diagnosed with early-stage cancer and had not yet begun treatment and were either attending or had been transferred to the gynecological oncology unit, who received fertility consultations through the hospital's Oncofertility program, who consented to be involved in the study, and who were willing to participate in a 30-minute in-person interview were chosen. G-Power software version 3.1.3 was used to determine the sample size. This study excluded women who had received fertility-threatening cancer treatment, had a secondary cancer, had a recurrence or remission of their cancer, had no ovaries or uterus, had bilateral ovarian cancer, were morbidly obese (BMI < 40), had a preexisting mental illness, or were incapable of providing informed consent. The t test was used to compare the mean awareness of the groups in the study with the following parameters: effect size 0.5 (assumed), alpha error 0.05, power (1-beta error probability) 0.95, and one tail. Eighteen individuals were needed for the sample size, plus an extra 10% to account for the nonresponse rate. For the investigation, a sample size of 20 was acquired and used. Data collection tools Data collection was performed via a structured interview questionnaire. It includes five tools. The first tool is the patient assessment tool. A structured patient assessment tool developed by the researchers for this study based on literature review. It was split into four parts: Part I, comprising personal and general traits such as age, occupation, residence, marital status, level of education, family income, height/cm, weight/kg and body mass index (BMI). Part II: obstetrical/labor characteristics if the woman was married, such as the number of pregnancies, last pregnancy complications, number of children, last delivery or abortion/years, and type of last delivery. Part III included 8 questions concerning the reproductive history of the women. The last part IV covered cancer-related data, such as cancer type/localization, stage of cancer, thoughts of pregnancy and wanted to preserve fertility. The second tool is the Infertility Knowledge Questionnaire (IKQ), which was created by Huang et al. (2019) with assistance from Taiwan's Ministry of Science and Technology (MOST) ( 9 ). It was used to examine how well-informed cancer patients were about infertility. There were eleven items on the scale overall, split across two subdomains: two items in the first category evaluated general knowledge about infertility, whereas nine items in the second domain evaluated knowledge about cancer and its treatments. Each item's response was categorized as either "yes/correct" = 1 or "no/incorrect/do not know" = 0. The total ratings varied from 0 to 11 points, with higher scores indicating a greater understanding of infertility. Each domain's knowledge level and overall knowledge were put into three categories: poor knowledge (> 5.5 or less than 50% of the maximum potential score), fair knowledge (5.5–7, or 50–65% of the maximum possible score), and good knowledge (< 7 or more than 65% of the maximum possible score). Five cancer patients examined facial validity, while five experts analyzed content validity. For relevance and importance, the IKQ's content validity index across expert evaluations was 0.96 and 0.95, respectively. Using Cronbach's α coefficient, the internal consistency of the IKQ scale was determined to be 0.84. The third tool is the Reproductive Concerns after Cancer (RCAC) scale, originally developed by Gorman et al., (2019), which measures the reproductive problems of female cancer patients ( 10 – 12 ). Partner disclosure, child health, personal health, acceptance, and fertility possibility and pregnancy are among its six dimensions, with a total of eighteen components. The ratings for items 13, 14, and 15 were reverse-scored, with a score of one for "strongly agree" and a score of five for "strongly disagree." Each item was graded from 1 for "strongly disagree" to 5 for "strongly agree." Higher scores indicate greater levels of worry. A significant degree of reproductive concern in a particular region was indicated by a mean value of ≥ 4 in that dimension. The sum of the scores for each of the six dimensions is the overall score. With a Cronbach's alpha of 0.89, the RCAC scale has shown strong validity and reliability. The fourth tool is the fertility intention scale (FIS), developed by Li et al. (2018), which is used to gauge cancer survivors' intentions to become parents ( 13 – 15 ). The FIS consists of 15 items that address four areas: happiness, social support, disease prevention, and pregnancy risk. The perceptions of the women regarding the safety and burden of pregnancy were determined to be the realm of pregnancy risk. As a result, patients were more willing to become pregnant when their chances of becoming pregnant were reduced (higher domain scores). The disease control domain evaluated how patients perceived the risk of illness and cancer. Perceived potential help from others and sentiments about being able to raise the next generation were measured by social support and happiness. A five-point Likert scale is used to score each item's response. A higher fertility intention is indicated by a higher overall fertility intention score (sum of the 15 items). For the FIS (15 items), the Cronbach's alpha was 0.88. Four factors that explained approximately 68.72% of the variation were found when factor analysis was performed to assess the scale's construct validity. The fifth tool was the Decisional Conflict Scale (DCS), developed by O’Connor (1995) ( 16 – 18 ). It has 16 items that address three domains: external pressure or support, uncertainty and effective decision-making, and clarity and informed values. Every item was given a rating between 0 and 4 on a five-point Likert scale. The score was determined by multiplying the product by 25 and then averaging the sum of the points for each individual component. As a result, the scores fall between 0 and 100. Higher decisional conflict is indicated by a higher score. The scale's Cronbach’s alpha was calculated and found to be 0.93. The procedure The Woman’s Health Hospital Oncology Board and the Faculty of Nursing Ethics Committee at Assiut University approved the study (Approval No. 11120240760). Data collection took place from March to August 2024. After tool development and validation by three specialists in gynecologic oncology, ART medicine, and nursing, a pilot study involving 10% of the sample was conducted to assess clarity and feasibility; as no modifications were required, these participants were included in the final sample. Eligible patients attending the gynecological oncology unit after fertility consultation were approached through referrals from oncologists, breast surgeons, and fertility specialists. The researcher explained the study, confirmed eligibility, and obtained informed consent, emphasizing voluntary participation and the right to withdraw at any time. Individual face-to-face interviews were conducted in a private room to ensure confidentiality and lasted 30–45 minutes. During the interview, the researcher collected personal, reproductive, obstetrical, and cancer-related data, followed by assessing infertility knowledge, reproductive concerns, fertility intentions, and decisional conflict. For women who expressed a desire for fertility preservation, the researcher provided education about available procedures and coordinated with fertility specialists, maintaining follow-up throughout the process. Statistical analysis: Statistical Package for the Social Sciences (SPSS), version 27.0 (IBM Corp., Somers, New York, USA), was used for the statistical analysis. Frequencies were used to describe categorical variables, whereas means ± standard deviations were used to portray continuous variables. When necessary, the Mann‒Whitney test or Student's t test was used to perform the bivariable analysis. When applicable, the chi-square test or Fisher’s exact test was used to compare categorical variables. To determine the variables influencing accurate answers to the questions, logistic regression analysis was performed. A P value of less than 0.05 was considered statistically significant. The significance level was defined as a P value < 0.05. RESULTS Table (1): Personal and general characteristics of the studied women (n = 20) Variables Frequency or mean ± SD Age/years Less than 20 7 20–30 9 30–40 4 Mean ± SD 24.9 ± 7.5 Occupation Housewife 18 Employed 2 Residence Urban 7 Rural 13 Marital status Single 10 Married 10 Level of education Illiterate or read &write 9 Secondary education 7 University education 4 Family income Inadequate 13 Adequate 7 Height/cm Mean ± SD 155.7 ± 5.9 Weight/kg Mean ± SD 70.7 ± 15.3 BMI Mean ± SD 29.2 ± 5.95 Normal weight 3 Overweight 16 Under weight 1 Table (1) Illustrates the personal and general attributes of the women under study and reports that nearly half of them (n = 9) were aged 20–30 years, with a mean ± SD of 24.9 ± 7.5. More than half of them lived in rural areas. With respect to the level of education, nearly half of the women were illiterate or read and write. More than two-thirds of the studied women were housewives. Half of them ( 10 ) were married, and those with a BMI greater than two-thirds ( 16 ) were overweight. Table (2): Obstetrical/labor characteristics of the studied women (n = 20) Variables Frequency Number of pregnancies (including miscarriages or abortions) 0 12 1 6 2–4 2 Last pregnancy complications No 2 Abortion 6 Number of children 0 18 ≥ 1 2 Last delivery or abortion/years 2–3 4 4–10 4 Type of last delivery Normal 1 Cesarean section 1 Table (2) presents the obstetrical/labor characteristics of the studied women and shows that more than half of the women ( 12 ) had not previously been pregnant and that more than two-thirds of the women ( 18 ) had no children. Table (3): Reproductive history of the studied women (n = 20) Variables Frequency Suffering from severe period pains Yes 13 No 7 History of pelvic surgery Yes 11 No 9 The menstrual cycle can be erratic. The period frequently arrives more than five days early or later than anticipated. (When not utilizing contraceptives) Yes 16 No 4 The menstrual cycle is shorter than twenty-one days. (When not utilizing contraceptives) Yes 10 No 10 The menstrual cycle lasts longer than thirty-five days. (When not utilizing contraceptives) Yes 10 No 10 Suffering from endometriosis Yes 4 No/Not sure 16 History of pelvic inflammatory disease (PID) Yes 9 No/Not sure 11 History of amenorrhea (When not utilizing contraceptives) Yes 9 No/Not sure 11 Table (3) Reveals the reproductive history of the studied women and reveals that more than half of the women ( 13 ) experienced severe pain. Additionally, more than half of them ( 11 ) had a history of pelvic surgery, and half of them ( 10 ) had a menstrual cycle shorter than twenty-one days when they did not utilize contraceptives. Nearly one quarter of them ( 4 ) were suffering from endometriosis, and nearly half of them ( 9 ) had a history of pelvic inflammatory disease. Table (4): Cancer-related data, thoughts about pregnancy and the desire to preserve the fertility of the studied women (n = 20) Variables Frequency Cancer type/localization Breast cancer 2 Cervical cancer 1 Endometrial 1 Ovarian 3 Gestational trophoblastic disease 3 Leukemia 2 Lymphoma 6 Brain tumor 1 Osteosarcoma 1 Stage of cancer 0 2 1 8 2 10 Thoughts of pregnancy Yes 19 No 1 Performing fertility preservation Yes 19 No 1 Table (4) Cancer-related data, thoughts of pregnancy and desires to perform fertility preservation for the studied women. More than one quarter of them ( 6 ) had lymphoma, half of them ( 10 ) were at the 2nd stage of cancer, and nearly all of the studied women ( 19 ) had thoughts of pregnancy and wanted to preserve their fertility. Table (5a): Infertility knowledge among the studied women (n = 20) : Variables Frequency or mean ± SD Level of infertility knowledge Poor knowledge 14 Fair knowledge 4 Good knowledge 2 Infertility Knowledge score General infertility knowledge .800 ± .89 Cancer/treatment-specific knowledge 3.30 ± 2.75 Total of infertility knowledge score 4.1 ± 3.3 Table (5a) Infertility knowledge among the studied women, nearly three quarters ( 14 ) reported poor knowledge. Table (5b): Reproductive concerns, fertility intentions and decisional conflicts among the studied women (n = 20) Variables Frequency or mean ± SD Level of reproductive concerns after cancer High reproductive concern 19 Moderate reproductive concern 1 Low reproductive concern 0 Total of reproductive concerns score 68.1 ± 10.7 Level of fertility intention High fertility intention 19 Moderate fertility intention 1 Low fertility intention 0 Fertility Intention Pregnancy risk 24.1 ± 2.7 Disease control 16.6 ± 2.7 Social support 11.2 ± 2.3 Happiness 8.6 ± 1.5 Total of fertility intention score 60.5 ± 7.6 Level of decisional Conflict Low decisional Conflict 15 High decisional Conflict 5 Total of decisional Conflict score 27.65±.12.5 Table (5b) Revealing the reproductive worries following cancer, fertility intention and conflict over decisions among the studied women. Regarding the degree of reproductive issues following cancer and level of fertility intention, nearly all the studied women ( 19 ) had high reproductive concern and high fertility intention; related to the level of decisional conflict, three quarters ( 15 ) had low decisional conflict. Table (6): Correlations between infertility knowledge, reproductive concerns, fertility intentions, decisional conflicts, and personal and obstetrical characteristics of the studied women Variables Infertility knowledge Reproductive concerns Fertility Intention Decisional conflict Age r. value 0.438 0.520 0.280 -0.097 P. value 0.054 0.019 * 0.232 0.683 Occupation r. value -0.263 -0.131 0.291 0.291 P. value 0.263 0.583 0.214 0.214 Residence r. value 0.101 -0.027 -0.046 0.192 P. value 0.672 0.909 0.848 0.418 Marital status r. value 0.377 0.558 0.366 -0.139 P. value 0.102 0.011 * 0.112 0.558 Level of education r. value 0.721 0.032 0.461 -0.108 P. value < 0.001** 0.892 0.041 * 0.649 Family income r. value 0.266 0.247 0.421 -0.119 P. value 0.256 0.294 0.065 0.618 Pregnancy history r. value 0.381 0.505 0.296 -0.099 P. value 0.098 0.023 * 0.205 0.679 Having children r. value 0.482 0.247 0.087 -0.029 P. value 0.031* 0.294 0.715 0.903 Pregnancy complications r. value 0.492 0.450 0.326 -0.046 P. value 0.028 * 0.047 * 0.161 0.847 Thoughts of pregnancy r. value 0.342 0.240 0.340 -0.020 P. value 0.140 0.308 0.142 0.933 Infertility knowledge r. value --- 0.369 0.432 -0.317 P. value --- 0.109 0.057 0.173 Reproductive concerns r. value 0.369 --- 0.587 -0.359 P. value 0.109 --- 0.006 ** 0.120 Fertility intention r. value 0.432 0.587 --- -0.133 P. value 0.057 0.006 ** --- 0.577 Decisional conflict r. value -0.317 -0.359 -0.133 --- P. value 0.173 0.120 0.577 --- Spearman's rho correlation **Correlation is significant at the 0.01 level (2-tailed). *Correlation is significant at the 0.05 level (2-tailed). Table (6) Correlations among infertility knowledge, reproductive concerns, fertility intentions, decisional conflicts, and personal and obstetrical characteristics of the studied women, which revealed highly significant differences between the levels of education and infertility knowledge and infertility intentions, with p values of < 0.001 and < 0.041, respectively. There was a significant difference between pregnancy history and reproductive concerns, with a p value < 0.023. There was a highly significant difference between having children and infertility knowledge, with a p value < 0.031. There was a significant difference between pregnancy complications and infertility knowledge, with reproductive concerns, with p values of 0.028 and 0.006. DISCUSSION The current study sought to determine how well-informed female cancer patients were about reproductive issues related to oncofertility preservation. The findings showed that nearly three‑quarters of the participants had limited infertility knowledge. This aligns with the results of McClam et al. (2024), who reported that most breast cancer patients lacked adequate understanding of oncofertility and expressed a need for clearer information regarding fertility preservation options and the reproductive effects of cancer treatment ( 5 ). Similar results were reported by Alsaif (2023), who highlighted the limited awareness among women in the Saudi population, further influenced by cultural and religious perceptions ( 19 ). Additionally, Zaami et al. (2022) suggested that although interest in fertility preservation exists, the uptake remains limited due to fear of invasive procedures, health‑related concerns, and misinformation ( 20 ). Findings from Omani‑Samani et al. (2021) similarly indicate insufficient awareness among adult cancer patients and parents of pediatric patients ( 21 ). A systematic review by Wang, Anazodo, and Logan (2019) further demonstrated that many cancer patients have unmet information needs related to fertility, resulting in uncertainty and difficulty in making informed fertility preservation decisions ( 22 ). Their review emphasized the importance of patient decision aids (PtDAs) in supporting clearer, more confident decision‑making for reproductive planning. Regarding reproductive concerns, fertility intentions, and decisional conflict, nearly all women in the present study showed high levels of reproductive concern and strong fertility intention, while most reported low decisional conflict. This is comparable to the findings of Ruggeri et al. (2019), who reported that many young breast cancer survivors continue to desire biological children after treatment ( 23 ). Likewise, Ruddy et al. (2014) found substantial concern about infertility among younger patients, even among those who already had children ( 24 ). The cross‑sectional study by Ramya Sindi (2020) also contributes context, showing that although approximately half of the surveyed cancer patients were aware of fertility preservation, few had discussed these options with healthcare providers before starting treatment ( 25 ). This highlights the ongoing need for public education and structured fertility counseling services. In contrast, Ko et al. (2023) observed that a proportion of older women expressed limited interest in learning about fertility preservation, often due to reduced desire for future childbearing ( 26 ). However, nearly half of the participants in their study reported that fertility concerns still influenced their treatment decisions, and some women changed their reproductive preferences after treatment. This reinforces the dynamic nature of fertility-related decision‑making among cancer patients. Our findings also revealed that younger and more educated women demonstrated better infertility knowledge, higher reproductive awareness, and stronger fertility intentions. This agrees with Ko et al. (2023), who reported that education level and age are strong predictors of fertility-related knowledge and interest in fertility preservation ( 26 ). The findings of this study highlight clear gaps in reproductive knowledge and access to fertility‑related information, which directly relate to Sustainable Development Goal 3.7. This global target calls for universal access to sexual and reproductive health services, including counseling, education, and decision‑support tools. The limited awareness observed among participants and the inconsistent provision of fertility counseling indicates that current practices fall short of SDG 3.7 commitments. Enhancing fertility education, integrating structured oncofertility counseling into routine oncology care, and ensuring equitable access to preservation services are essential steps toward supporting reproductive rights and improving the long‑term well‑being of young women with cancer. Conclusion and recommendations It can be concluded that young women have a high level of reproductive concern and intention but a poor level of understanding of infertility preservation. This study revealed that female cancer patients need to be more aware of reproductive issues to maintain their ability to conceive. These findings also suggest that health care providers should tell patients more about the effects of cancer treatment on fertility and the options available for preserving fertility. Limitations There were several difficulties in this study, but the main difficulty was financial strain because the majority of the participants did not have enough money, and the high expense of fertility preservation operations was a significant obstacle. The second drawback is that many cases are detected at an advanced stage, and the prognosis for others is not good. Additional restrictions include the need to begin chemotherapy immediately and the fact that half of the participants were unmarried, which made it harder for patients to express a wish for fertility according to Eastern norms. This may also make it more difficult for the researcher to talk to patients about fertility difficulties. Finally, another constraint was the decision-making process, which included family members. The small sample size was caused by several factors, including the length of the questionnaire and the amount of time the researcher spent with each participant in an effort to avoid burdening the patient. Clinical implications In addition to improving the knowledge and awareness level of oncology females about fertility preservation, this study has a significant impact on convincing patients’ families and encouraging female patients to perform fertility preservation, as 19/20 females perform fertility preservation. The greatest impact of this study was that the hospital made the decision to preserve fertility for cancer patients at the state's expense. The hospital also bears a portion of the costs, easing the financial burden for females who cannot afford it. Abbreviations Body Mass Index (BMI) Decisional Conflict Scale (DCS) Fertility Intention Scale (FIS) Infertility Knowledge Questionnaire (IKQ) Ministry of Science and Technology (MOST) Patient decision aids (PtDAs) Reproductive Concerns after Cancer. (RCAC) Statistical Package for the Social Sciences (SPSS) Declarations Author Contribution AA and TB conceptualized and designed the study. HM and GA were responsible for data collection and field supervision. AK and AI performed data entry, statistical analysis, and interpretation. MT drafted the initial manuscript. AA and TB critically revised the manuscript for important intellectual content. All authors read and approved the final version of the manuscript. Ethical approval The study was approved by the Scientific Research Ethics Committee, Faculty of Nursing, Assiut University (Approval No. 1120240760). Every participant gave their informed consent to the study. The study was conducted in accordance with the Declaration of Helsinki. Consent for publication Not Applicable. Data statement The researchers attest that all pertinent data have been included in the results of this paper. No information was left out of the analyses. The corresponding author has made the datasets used in this investigation accessible. Funding The authors affirm that no funding, money, or other assistance was obtained to prepare this work. Acknowledgments The authors sincerely acknowledge the cooperation of all the women involved in this study. We also extend our appreciation to the administrative and nursing staff of the study setting for their assistance and support throughout the data collection process. Competing interest The authors declare no competing interests. References Monaco S. SDG 3. Ensure healthy lives and promote well‑being for all at all ages. In: Identity, Territories, and Sustainability: Challenges and Opportunities for Achieving the UN Sustainable Development Goals. Emerald Publishing; 2024. p. 33–41. doi:10.1108/978183797549520241004. World Health Organization. Towards a global action plan for healthy lives and well‑being for all: uniting to accelerate progress towards the health‑related SDGs. Geneva: WHO; 2018. Report No.: WHO/DCO/2018.3. Available from: https://www.who.int/publications/i/item/WHO-DCO-2018.3. Hassan A, Golub S. Sexual and reproductive health goals and the 2030 global agenda for sustainable development: progress, prospects, and challenges. J Pediatr Adolesc Gynecol. 2025;38(1):13–17. doi:10.1016/j.jpag.2024.09.002. Daher‑Nashif S, Bawadi H. Women’s health and well‑being in the United Nations sustainable development goals: a narrative review of achievements and gaps in the Gulf States. Int J Environ Res Public Health. 2020;17(3):1059. doi:10.3390/ijerph17031059. McClam M, Yan R, Su Y, Xiao S, Zhang X. Knowledge, attitude, and behavior towards oncofertility among female breast cancer patients in China. Research Square [preprint]. 2024. doi:10.21203/rs.3.rs‑5427433/v1. Huang S‑M, Kao T‑S, Lien P‑J, Hsieh P‑L, Chen P‑H, Tseng L‑M. Oncofertility care: a qualitative study to understand personal perspectives and barriers in the multidisciplinary breast care team in Taiwan. Women’s Health. 2022;18:17455057221078480. doi:10.1177/17455057221078480. Liu K, Nicoletti R, Zhao H, Chen X, Wu H, Leung CH, et al. Young age and adequate BCG are key factors for optimal BCG treatment efficacy in non‑muscle invasive bladder cancer. World J Urol. 2024;42(1):547. doi:10.1007/s00345‑024‑05218‑4. Semler R, Thom B. Fertility preservation: improving access through nurse‑advocated financial assistance. Clin J Oncol Nurs. 2019;23(5):27–30. doi:10.1188/19.CJON.S2.27‑30. Huang S‑M, Tseng L‑M, Lai JCY, Lien P‑J, Chen P‑H. Infertility‑related knowledge in childbearing‑age women with breast cancer after chemotherapy. Int J Nurs Pract. 2019;25(5):e12765. doi:10.1111/ijn.12765. Gorman JR, Pan‑Weisz TM, Drizin JH, Su HI, Malcarne VL. Revisiting the Reproductive Concerns After Cancer (RCAC) scale. Psychooncology. 2019;28(7):1544–1550. doi:10.1002/pon.5130. Qiao T‑T, Zheng W, Xing W, Zhang L‑X, Zhang W, Shi Y‑P, Chen X‑J. Psychometric properties of the Chinese version of the Reproductive Concerns After Cancer Scale (RCAC) for young female cancer survivors. Support Care Cancer. 2017;25:1263–1270. doi:10.1007/s00520-016-3519-1. Bártolo A, Santos IM, Valério E, Costa A, Reis S, Raposo S, Monteiro S. The European Portuguese version of the Reproductive Concerns After Cancer Scale (RCACS): a psychometric validation for young adult female cancer survivors. Eur J Oncol Nurs. 2020;47:101781. doi:10.1016/j.ejon.2020.101781. Toprak FÜ, Uysal N, Turan Z, Akduran F. Fertility Intention Scale in Breast Cancer Survivors: Turkish validity and reliability study. Semin Oncol Nurs. 2025;151894. doi:10.1016/j.soncn.2025.151894. Zhu F, Liu C, Qi J, Bian Y, Pang L, Lu Q. Psychometric properties of the Fertility Intention Scale among patients with breast cancer of childbearing age in mainland China. Asia Pac J Oncol Nurs. 2022;9(8):100100. doi:10.1016/j.apjon.2022.100100. Li CC, Huang SM, Lai JCY, Hsiung Y, Chen YH, Lee CF. Development and validation of a fertility intention scale in breast cancer survivors. J Nurs Res. 2018;26(3):177–184. doi:10.1097/jnr.0000000000000223. O’Connor AM. Validation of a decisional conflict scale. Med Decis Making. 1995;15(1):25–30. doi:10.1177/0272989X9501500105. Garvelink MM, Boland L, Klein K, Nguyen DV, Menear M, Bekker HL, et al. Decisional conflict scale findings among patients and surrogates making health decisions: part II of an anniversary review. Med Decis Making. 2019;39(4):316–327. doi:10.1177/0272989X19851346. Kawaguchi T, Azuma K, Yamaguchi T, Soeda H, Sekine Y, Koinuma M, et al. Development and validation of the Japanese version of the Decisional Conflict Scale to investigate the value of pharmacists’ information: a before and after study. BMC Med Inform Decis Mak. 2013;13:50. doi:10.1186/1472-6947-13-50. Alsaif RA. Exploring the level of knowledge and attitudes among female cancer patients towards fertility preservation in KSA. Int J Novel Res Healthc Nurs. 2023;10(6):1–12. doi:10.5281/zenodo.10141918. Zaami S, Melcarne R, Patrone R, Gullo G, Negro F, Napoletano G, et al. Oncofertility and reproductive counseling in patients with breast cancer: a retrospective study. J Clin Med. 2022;11(5):1311. doi:10.3390/jcm11051311. Omani‑Samani R, Vesali S, Navid B, Mohajeri M, Rafsanjani KA, Aghamaleki SZN, et al. Adult cancer patients and parents of younger cancer patients have little information about fertility preservation: a survey of knowledge and attitude. Middle East Fertil Soc J. 2021;26:25. doi:10.1186/s43043-021-00072-5. Wang Y, Anazodo A, Logan S. Systematic review of fertility preservation patient decision aids for cancer patients. Psycho‑Oncology. 2019;28(3):459–467. doi:10.1002/pon.4961. Ruggeri M, Pagan E, Bagnardi V, Bianco N, Gallerani E, Buser K, et al. Fertility concerns, preservation strategies and quality of life in young women with breast cancer: baseline results from an ongoing prospective cohort study in selected European centers. Breast. 2019;47:85–92. doi:10.1016/j.breast.2019.07.006. Ruddy KJ, Gelber SI, Tamimi RM, Ginsburg ES, Schapira L, Come SE, et al. Prospective study of fertility concerns and preservation strategies in young women with breast cancer. J Clin Oncol. 2014;32(11):1151–1156. doi:10.1200/JCO.2013.52.8877. Sindi RA, Bagabas MS, Al‑Manabre LM, Alqasmi RZ, Rednah RY, Al‑Jahdali SM, et al. Fertility preservation in cancer patients: evaluation of knowledge, attitude, and practice of health practitioners towards fertility preservation in Makkah region of Saudi Arabia. In: Proceedings of the 1st International Conference on Creativity, Technology, and Sustainability (CCTS 2024). Springer; 2025. p. 509–520. doi:10.1007/978-981-97-8588-9_48. Ko JKY, Cheung CSY, Cheng HHY, Yung SSF, Ng TY, Tin WWY, et al. Knowledge, attitudes and intention on fertility preservation among breast cancer patients. Sci Rep. 2023;13(1):9645. doi:10.1038/s41598-023-36377-w. Additional Declarations No competing interests reported. Supplementary Files SupplementaryFile1Questionnaire.doc Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 08 Apr, 2026 Reviews received at journal 05 Apr, 2026 Reviews received at journal 29 Mar, 2026 Reviewers agreed at journal 29 Mar, 2026 Reviewers agreed at journal 29 Mar, 2026 Reviewers agreed at journal 29 Mar, 2026 Reviewers invited by journal 29 Mar, 2026 Editor assigned by journal 24 Mar, 2026 Submission checks completed at journal 23 Mar, 2026 First submitted to journal 23 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9003906","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":615002338,"identity":"b362a1f5-8b60-4cdc-af4d-14ef3dcfc80f","order_by":0,"name":"Aya M. Abdelhafez","email":"","orcid":"","institution":"Assiut, University","correspondingAuthor":false,"prefix":"","firstName":"Aya","middleName":"M.","lastName":"Abdelhafez","suffix":""},{"id":615002345,"identity":"9aef6155-e2e5-4384-a82e-622f23489768","order_by":1,"name":"Heba M. Mohamed","email":"","orcid":"","institution":"Al-Ahliyya -Amman-University","correspondingAuthor":false,"prefix":"","firstName":"Heba","middleName":"M.","lastName":"Mohamed","suffix":""},{"id":615002348,"identity":"4a7e864f-a08e-40a9-8e24-52e76d1e67f5","order_by":2,"name":"Alaa El-Din Mahmoud Ismail","email":"","orcid":"","institution":"Assiut, University","correspondingAuthor":false,"prefix":"","firstName":"Alaa","middleName":"El-Din Mahmoud","lastName":"Ismail","suffix":""},{"id":615002349,"identity":"0bb1805b-ad62-44e3-b245-4b2acda35ded","order_by":3,"name":"A.F Abdel-Kawi","email":"","orcid":"","institution":"Assiut University","correspondingAuthor":false,"prefix":"","firstName":"A.F","middleName":"","lastName":"Abdel-Kawi","suffix":""},{"id":615002350,"identity":"44e6a7b8-176c-4690-a272-c264fee9743c","order_by":4,"name":"Mohammed Ibrahim Touni","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA3UlEQVRIiWNgGAWjYDACZgaGw0AqgY2B+YABkMHYQFgLM0wLWwKRWoDWMIO0MDDwgHQQoUW3nf/g4cI9dnl8Ymc+FPMw2MhuOMD+8AM+LWaHgQ6b8Sy5mE06d4MxD0Oa8YYDPMYSBLXwHGBObINoOZwI1MJAjJZ6oJacB0At/4Fa2B//IELLYZAWBqCWA0AtDGaEbDE4POPAcaCWNAPDOQbJxjMP85hZ4NVy/uDjzwUHqhPnz05+ZvCmwk6273j74xv4tCADNgMGUNQwE6sepPYBCYpHwSgYBaNgBAEAZXlJ7eDqHjcAAAAASUVORK5CYII=","orcid":"","institution":"Jouf University","correspondingAuthor":true,"prefix":"","firstName":"Mohammed","middleName":"Ibrahim","lastName":"Touni","suffix":""},{"id":615002351,"identity":"5b91f6b0-e773-47ce-8774-395bdd811bf7","order_by":5,"name":"Ghada Hassan Ahmed","email":"","orcid":"","institution":"Jerash University- Jerash","correspondingAuthor":false,"prefix":"","firstName":"Ghada","middleName":"Hassan","lastName":"Ahmed","suffix":""},{"id":615002352,"identity":"c72bdda2-ef98-430c-a554-2c8443da2692","order_by":6,"name":"Treza S. Badia","email":"","orcid":"","institution":"Assiut University","correspondingAuthor":false,"prefix":"","firstName":"Treza","middleName":"S.","lastName":"Badia","suffix":""}],"badges":[],"createdAt":"2026-03-01 21:23:34","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9003906/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9003906/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106008474,"identity":"41e03ea8-655a-4af0-bc0c-8f92f4660785","added_by":"auto","created_at":"2026-04-02 11:12:33","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1365400,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9003906/v1/3cfe3c1e-9da6-4dd1-96d8-cc24c7b69853.pdf"},{"id":106008427,"identity":"f026eae4-e7c1-4549-8663-021dcb0c1ff0","added_by":"auto","created_at":"2026-04-02 11:12:26","extension":"doc","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":173568,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFile1Questionnaire.doc","url":"https://assets-eu.researchsquare.com/files/rs-9003906/v1/0fac3f1ac4db90233e86339d.doc"}],"financialInterests":"No competing interests reported.","formattedTitle":"Reproductive Concerns and Awareness of Oncofertility Preservation among Female Cancer Patients: Implications for Sustainability","fulltext":[{"header":"Introduction","content":"\u003cp\u003eWomen\u0026rsquo;s reproductive health is a global priority reflected in Sustainable development goal 3, which calls for equitable access to high-quality reproductive health services and reliable information by 2030 (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). SDG 3.7 further emphasizes the need to integrate sexual and reproductive health counseling into routine care, a goal particularly relevant for women at risk of treatment-related infertility (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). As cancer survival improves, fertility preservation has become an essential dimension of survivorship, supporting long-term well-being and quality of life for female cancer patients (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFor women diagnosed during their reproductive years, fertility concerns are common and often emotionally distressing. Evidence shows that maintaining the possibility of future childbearing supports psychological adjustment, whereas anticipated infertility contributes to worry and reduced well-being. Despite international recommendations for early fertility counseling, gaps in communication and limited access to fertility information remain (\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eNurses play a central role in supporting decision-making by offering education, emotional support, and coordination across oncology and fertility services (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Strengthening this role is important to ensure that women receive consistent and timely guidance. Understanding women\u0026rsquo;s awareness of reproductive risks and available preservation options is therefore essential. This study aims to explore female cancer patients\u0026rsquo; awareness of reproductive concerns related to oncofertility preservation.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and setting\u003c/h2\u003e \u003cp\u003eA case series study design was carried out from March to the end of August 2024 at the gynecological oncology unit in collaboration with the assisted reproductive technology unit at Woman Health Hospital, Assiut University, Egypt. This hospital is a large university teaching hospital that receives patients from all over Upper Egypt.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eParticipants\u003c/h3\u003e\n\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eA purposive sample of twenty women between the ages of 16 and 40 years who had been recently diagnosed with early-stage cancer and had not yet begun treatment and were either attending or had been transferred to the gynecological oncology unit, who received fertility consultations through the hospital's Oncofertility program, who consented to be involved in the study, and who were willing to participate in a 30-minute in-person interview were chosen. G-Power software version 3.1.3 was used to determine the sample size. This study excluded women who had received fertility-threatening cancer treatment, had a secondary cancer, had a recurrence or remission of their cancer, had no ovaries or uterus, had bilateral ovarian cancer, were morbidly obese (BMI\u0026thinsp;\u0026lt;\u0026thinsp;40), had a preexisting mental illness, or were incapable of providing informed consent. The t test was used to compare the mean awareness of the groups in the study with the following parameters: effect size 0.5 (assumed), alpha error 0.05, power (1-beta error probability) 0.95, and one tail. Eighteen individuals were needed for the sample size, plus an extra 10% to account for the nonresponse rate. For the investigation, a sample size of 20 was acquired and used.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eData collection tools\u003c/h3\u003e\n\u003cp\u003eData collection was performed via a structured interview questionnaire. It includes five tools. The first tool is the patient assessment tool. A structured patient assessment tool developed by the researchers for this study based on literature review. It was split into four parts: Part I, comprising personal and general traits such as age, occupation, residence, marital status, level of education, family income, height/cm, weight/kg and body mass index (BMI). Part II: obstetrical/labor characteristics if the woman was married, such as the number of pregnancies, last pregnancy complications, number of children, last delivery or abortion/years, and type of last delivery. Part III included 8 questions concerning the reproductive history of the women. The last part IV covered cancer-related data, such as cancer type/localization, stage of cancer, thoughts of pregnancy and wanted to preserve fertility. The second tool is the Infertility Knowledge Questionnaire (IKQ), which was created by Huang et al. (2019) with assistance from Taiwan's Ministry of Science and Technology (MOST) (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). It was used to examine how well-informed cancer patients were about infertility. There were eleven items on the scale overall, split across two subdomains: two items in the first category evaluated general knowledge about infertility, whereas nine items in the second domain evaluated knowledge about cancer and its treatments. Each item's response was categorized as either \"yes/correct\" = 1 or \"no/incorrect/do not know\" = 0. The total ratings varied from 0 to 11 points, with higher scores indicating a greater understanding of infertility. Each domain's knowledge level and overall knowledge were put into three categories: poor knowledge (\u0026gt;\u0026thinsp;5.5 or less than 50% of the maximum potential score), fair knowledge (5.5\u0026ndash;7, or 50\u0026ndash;65% of the maximum possible score), and good knowledge (\u0026lt;\u0026thinsp;7 or more than 65% of the maximum possible score). Five cancer patients examined facial validity, while five experts analyzed content validity. For relevance and importance, the IKQ's content validity index across expert evaluations was 0.96 and 0.95, respectively. Using Cronbach's α coefficient, the internal consistency of the IKQ scale was determined to be 0.84. The third tool is the Reproductive Concerns after Cancer (RCAC) scale, originally developed by Gorman et al., (2019), which measures the reproductive problems of female cancer patients (\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Partner disclosure, child health, personal health, acceptance, and fertility possibility and pregnancy are among its six dimensions, with a total of eighteen components. The ratings for items 13, 14, and 15 were reverse-scored, with a score of one for \"strongly agree\" and a score of five for \"strongly disagree.\" Each item was graded from 1 for \"strongly disagree\" to 5 for \"strongly agree.\" Higher scores indicate greater levels of worry. A significant degree of reproductive concern in a particular region was indicated by a mean value of \u0026ge;\u0026thinsp;4 in that dimension. The sum of the scores for each of the six dimensions is the overall score. With a Cronbach's alpha of 0.89, the RCAC scale has shown strong validity and reliability. The fourth tool is the fertility intention scale (FIS), developed by Li et al. (2018), which is used to gauge cancer survivors' intentions to become parents (\u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). The FIS consists of 15 items that address four areas: happiness, social support, disease prevention, and pregnancy risk. The perceptions of the women regarding the safety and burden of pregnancy were determined to be the realm of pregnancy risk. As a result, patients were more willing to become pregnant when their chances of becoming pregnant were reduced (higher domain scores). The disease control domain evaluated how patients perceived the risk of illness and cancer. Perceived potential help from others and sentiments about being able to raise the next generation were measured by social support and happiness. A five-point Likert scale is used to score each item's response. A higher fertility intention is indicated by a higher overall fertility intention score (sum of the 15 items). For the FIS (15 items), the Cronbach's alpha was 0.88. Four factors that explained approximately 68.72% of the variation were found when factor analysis was performed to assess the scale's construct validity. The fifth tool was the Decisional Conflict Scale (DCS), developed by O\u0026rsquo;Connor (1995) (\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). It has 16 items that address three domains: external pressure or support, uncertainty and effective decision-making, and clarity and informed values. Every item was given a rating between 0 and 4 on a five-point Likert scale. The score was determined by multiplying the product by 25 and then averaging the sum of the points for each individual component. As a result, the scores fall between 0 and 100. Higher decisional conflict is indicated by a higher score. The scale's Cronbach\u0026rsquo;s alpha was calculated and found to be 0.93.\u003c/p\u003e\n\u003ch3\u003eThe procedure\u003c/h3\u003e\n\u003cp\u003e The Woman\u0026rsquo;s Health Hospital Oncology Board and the Faculty of Nursing Ethics Committee at Assiut University approved the study (Approval No. 11120240760). Data collection took place from March to August 2024. After tool development and validation by three specialists in gynecologic oncology, ART medicine, and nursing, a pilot study involving 10% of the sample was conducted to assess clarity and feasibility; as no modifications were required, these participants were included in the final sample.\u003c/p\u003e \u003cp\u003eEligible patients attending the gynecological oncology unit after fertility consultation were approached through referrals from oncologists, breast surgeons, and fertility specialists. The researcher explained the study, confirmed eligibility, and obtained informed consent, emphasizing voluntary participation and the right to withdraw at any time. Individual face-to-face interviews were conducted in a private room to ensure confidentiality and lasted 30\u0026ndash;45 minutes.\u003c/p\u003e \u003cp\u003eDuring the interview, the researcher collected personal, reproductive, obstetrical, and cancer-related data, followed by assessing infertility knowledge, reproductive concerns, fertility intentions, and decisional conflict. For women who expressed a desire for fertility preservation, the researcher provided education about available procedures and coordinated with fertility specialists, maintaining follow-up throughout the process.\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis:\u003c/h2\u003e \u003cp\u003eStatistical Package for the Social Sciences (SPSS), version 27.0 (IBM Corp., Somers, New York, USA), was used for the statistical analysis. Frequencies were used to describe categorical variables, whereas means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviations were used to portray continuous variables. When necessary, the Mann‒Whitney test or Student's t test was used to perform the bivariable analysis. When applicable, the chi-square test or Fisher\u0026rsquo;s exact test was used to compare categorical variables. To determine the variables influencing accurate answers to the questions, logistic regression analysis was performed. A P value of less than 0.05 was considered statistically significant. The significance level was defined as a P value\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003e \u003cb\u003eTable\u0026nbsp;(1): Personal and general characteristics of the studied women (n\u0026thinsp;=\u0026thinsp;20)\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency or mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAge/years\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess than 20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20\u0026ndash;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30\u0026ndash;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24.9\u0026thinsp;\u0026plusmn;\u0026thinsp;7.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eOccupation\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHousewife\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eResidence\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eLevel of education\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIlliterate or read \u0026amp;write\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUniversity education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eFamily income\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInadequate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdequate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eHeight/cm\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e155.7\u0026thinsp;\u0026plusmn;\u0026thinsp;5.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eWeight/kg\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70.7\u0026thinsp;\u0026plusmn;\u0026thinsp;15.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eBMI\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29.2\u0026thinsp;\u0026plusmn;\u0026thinsp;5.95\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNormal weight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverweight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnder weight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eTable\u0026nbsp;(1)\u003c/b\u003e Illustrates the personal and general attributes of the women under study and reports that nearly half of them (n\u0026thinsp;=\u0026thinsp;9) were aged 20\u0026ndash;30 years, with a mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD of 24.9\u0026thinsp;\u0026plusmn;\u0026thinsp;7.5. More than half of them lived in rural areas. With respect to the level of education, nearly half of the women were illiterate or read and write. More than two-thirds of the studied women were housewives. Half of them (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e) were married, and those with a BMI greater than two-thirds (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) were overweight.\u003c/p\u003e \u003cp\u003e \u003cb\u003eTable\u0026nbsp;(2): Obstetrical/labor characteristics of the studied women (n\u0026thinsp;=\u0026thinsp;20)\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabb\" border=\"1\"\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eNumber of pregnancies (including miscarriages or abortions)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u0026ndash;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eLast pregnancy complications\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbortion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eNumber of children\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLast delivery or abortion/years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u0026ndash;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u0026ndash;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eType of last delivery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCesarean section\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eTable\u0026nbsp;(2)\u003c/b\u003e presents the obstetrical/labor characteristics of the studied women and shows that more than half of the women (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) had not previously been pregnant and that more than two-thirds of the women (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e) had no children.\u003c/p\u003e \u003cp\u003e \u003cb\u003eTable\u0026nbsp;(3): Reproductive history of the studied women (n\u0026thinsp;=\u0026thinsp;20)\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabc\" border=\"1\"\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eSuffering from severe period pains\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eHistory of pelvic surgery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eThe menstrual cycle can be erratic. The period frequently arrives more than five days early or later than anticipated. (When not utilizing contraceptives)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eThe menstrual cycle is shorter than twenty-one days. (When not utilizing contraceptives)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eThe menstrual cycle lasts longer than thirty-five days. (When not utilizing contraceptives)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eSuffering from endometriosis\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo/Not sure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eHistory of pelvic inflammatory disease (PID)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo/Not sure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eHistory of amenorrhea (When not utilizing contraceptives)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo/Not sure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eTable\u0026nbsp;(3)\u003c/b\u003e Reveals the reproductive history of the studied women and reveals that more than half of the women (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) experienced severe pain. Additionally, more than half of them (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) had a history of pelvic surgery, and half of them (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e) had a menstrual cycle shorter than twenty-one days when they did not utilize contraceptives. Nearly one quarter of them (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) were suffering from endometriosis, and nearly half of them (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) had a history of pelvic inflammatory disease.\u003c/p\u003e \u003cp\u003e \u003cb\u003eTable\u0026nbsp;(4): Cancer-related data, thoughts about pregnancy and the desire to preserve the fertility of the studied women (n\u0026thinsp;=\u0026thinsp;20)\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabd\" border=\"1\"\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCancer type/localization\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBreast cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCervical cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEndometrial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOvarian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGestational trophoblastic disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeukemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLymphoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBrain tumor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOsteosarcoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eStage of cancer\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eThoughts of pregnancy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePerforming fertility preservation\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eTable\u0026nbsp;(4)\u003c/b\u003e Cancer-related data, thoughts of pregnancy and desires to perform fertility preservation for the studied women. More than one quarter of them (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) had lymphoma, half of them (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e) were at the 2nd stage of cancer, and nearly all of the studied women (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) had thoughts of pregnancy and wanted to preserve their fertility.\u003c/p\u003e \u003cp\u003e \u003cb\u003eTable\u0026nbsp;(5a): Infertility knowledge among the studied women (n\u0026thinsp;=\u0026thinsp;20)\u003c/b\u003e:\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabe\" border=\"1\"\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency or mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eLevel of infertility knowledge\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoor knowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFair knowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGood knowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInfertility Knowledge score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeneral infertility knowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.800 \u0026plusmn;\u0026thinsp;.89\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCancer/treatment-specific knowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.30\u0026thinsp;\u0026plusmn;\u0026thinsp;2.75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal of infertility knowledge score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.1\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eTable\u0026nbsp;(5a)\u003c/strong\u003e \u003cp\u003eInfertility knowledge among the studied women, nearly three quarters (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) reported poor knowledge.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eTable\u0026nbsp;(5b): Reproductive concerns, fertility intentions and decisional conflicts among the studied women (n\u0026thinsp;=\u0026thinsp;20)\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabf\" border=\"1\"\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency or mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eLevel of reproductive concerns after cancer\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh reproductive concern\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate reproductive concern\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow reproductive concern\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal of reproductive concerns score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e68.1\u0026thinsp;\u0026plusmn;\u0026thinsp;10.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eLevel of fertility intention\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh fertility intention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate fertility intention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow fertility intention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFertility Intention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePregnancy risk\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24.1\u0026thinsp;\u0026plusmn;\u0026thinsp;2.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDisease control\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16.6\u0026thinsp;\u0026plusmn;\u0026thinsp;2.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11.2\u0026thinsp;\u0026plusmn;\u0026thinsp;2.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHappiness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal of fertility intention score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60.5\u0026thinsp;\u0026plusmn;\u0026thinsp;7.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eLevel of decisional Conflict\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow decisional Conflict\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh decisional Conflict\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal of decisional Conflict score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27.65\u0026plusmn;.12.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eTable\u0026nbsp;(5b)\u003c/strong\u003e \u003cp\u003eRevealing the reproductive worries following cancer, fertility intention and conflict over decisions among the studied women. Regarding the degree of reproductive issues following cancer and level of fertility intention, nearly all the studied women (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) had high reproductive concern and high fertility intention; related to the level of decisional conflict, three quarters (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) had low decisional conflict.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eTable\u0026nbsp;(6): Correlations between infertility knowledge, reproductive concerns, fertility intentions, decisional conflicts, and personal and obstetrical characteristics of the studied women\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabg\" border=\"1\"\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eInfertility knowledge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReproductive concerns\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFertility Intention\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDecisional conflict\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003er. value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.438\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.520\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.280\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.097\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eP. value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.054\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.019\u003c/b\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.232\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.683\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eOccupation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003er. value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.263\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.131\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.291\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.291\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eP. value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.263\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.583\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.214\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.214\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eResidence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003er. value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.027\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.046\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.192\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eP. value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.672\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.909\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.848\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.418\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003er. value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.377\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.558\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.366\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.139\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eP. value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.102\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.011\u003c/b\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.558\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eLevel of education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003er. value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.721\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.032\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.461\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.108\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eP. value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001**\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.892\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.041\u003c/b\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.649\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFamily income\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003er. value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.266\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.247\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.421\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.119\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eP. value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.256\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.294\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.065\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.618\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePregnancy history\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003er. value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.381\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.505\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.296\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.099\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eP. value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.098\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.023\u003c/b\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.205\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.679\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHaving children\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003er. value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.482\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.247\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.087\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.029\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eP. value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.031*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.294\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.715\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.903\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePregnancy complications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003er. value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.492\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.450\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.326\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.046\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eP. value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.028\u003c/b\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.047\u003c/b\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.161\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.847\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eThoughts of pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003er. value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.342\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.240\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.340\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.020\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eP. value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.140\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.308\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.142\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.933\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eInfertility knowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003er. value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e---\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.369\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.432\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.317\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eP. value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e---\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.109\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.057\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.173\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eReproductive concerns\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003er. value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.369\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e---\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.587\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.359\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eP. value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.109\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e---\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.006\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.120\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFertility intention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003er. value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.432\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.587\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e---\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.133\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eP. value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.057\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.006\u003c/b\u003e\u003csup\u003e\u003cb\u003e**\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e---\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.577\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDecisional conflict\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003er. value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.317\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.359\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.133\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e---\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eP. value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.173\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.577\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e---\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eSpearman's rho correlation **Correlation is significant at the 0.01 level (2-tailed). *Correlation is significant at the 0.05 level (2-tailed).\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eTable\u0026nbsp;(6)\u003c/strong\u003e \u003cp\u003eCorrelations among infertility knowledge, reproductive concerns, fertility intentions, decisional conflicts, and personal and obstetrical characteristics of the studied women, which revealed highly significant differences between the levels of education and infertility knowledge and infertility intentions, with p values of \u0026lt;\u0026thinsp;0.001 and \u0026lt;\u0026thinsp;0.041, respectively. There was a significant difference between pregnancy history and reproductive concerns, with a p value\u0026thinsp;\u0026lt;\u0026thinsp;0.023. There was a highly significant difference between having children and infertility knowledge, with a p value\u0026thinsp;\u0026lt;\u0026thinsp;0.031. There was a significant difference between pregnancy complications and infertility knowledge, with reproductive concerns, with p values of 0.028 and \u0026lt;\u0026thinsp;0.047, respectively, and there was a significant difference between fertility intentions and reproductive concerns, with a p value\u0026thinsp;\u0026gt;\u0026thinsp;0.006.\u003c/p\u003e \u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe current study sought to determine how well-informed female cancer patients were about reproductive issues related to oncofertility preservation. The findings showed that nearly three‑quarters of the participants had limited infertility knowledge. This aligns with the results of McClam et al. (2024), who reported that most breast cancer patients lacked adequate understanding of oncofertility and expressed a need for clearer information regarding fertility preservation options and the reproductive effects of cancer treatment (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Similar results were reported by Alsaif (2023), who highlighted the limited awareness among women in the Saudi population, further influenced by cultural and religious perceptions (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Additionally, Zaami et al. (2022) suggested that although interest in fertility preservation exists, the uptake remains limited due to fear of invasive procedures, health‑related concerns, and misinformation (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Findings from Omani‑Samani et al. (2021) similarly indicate insufficient awareness among adult cancer patients and parents of pediatric patients (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA systematic review by Wang, Anazodo, and Logan (2019) further demonstrated that many cancer patients have unmet information needs related to fertility, resulting in uncertainty and difficulty in making informed fertility preservation decisions (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Their review emphasized the importance of patient decision aids (PtDAs) in supporting clearer, more confident decision‑making for reproductive planning.\u003c/p\u003e \u003cp\u003eRegarding reproductive concerns, fertility intentions, and decisional conflict, nearly all women in the present study showed high levels of reproductive concern and strong fertility intention, while most reported low decisional conflict. This is comparable to the findings of Ruggeri et al. (2019), who reported that many young breast cancer survivors continue to desire biological children after treatment (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Likewise, Ruddy et al. (2014) found substantial concern about infertility among younger patients, even among those who already had children (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe cross‑sectional study by Ramya Sindi (2020) also contributes context, showing that although approximately half of the surveyed cancer patients were aware of fertility preservation, few had discussed these options with healthcare providers before starting treatment (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). This highlights the ongoing need for public education and structured fertility counseling services.\u003c/p\u003e \u003cp\u003eIn contrast, Ko et al. (2023) observed that a proportion of older women expressed limited interest in learning about fertility preservation, often due to reduced desire for future childbearing (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). However, nearly half of the participants in their study reported that fertility concerns still influenced their treatment decisions, and some women changed their reproductive preferences after treatment. This reinforces the dynamic nature of fertility-related decision‑making among cancer patients.\u003c/p\u003e \u003cp\u003eOur findings also revealed that younger and more educated women demonstrated better infertility knowledge, higher reproductive awareness, and stronger fertility intentions. This agrees with Ko et al. (2023), who reported that education level and age are strong predictors of fertility-related knowledge and interest in fertility preservation (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe findings of this study highlight clear gaps in reproductive knowledge and access to fertility‑related information, which directly relate to Sustainable Development Goal 3.7. This global target calls for universal access to sexual and reproductive health services, including counseling, education, and decision‑support tools. The limited awareness observed among participants and the inconsistent provision of fertility counseling indicates that current practices fall short of SDG 3.7 commitments. Enhancing fertility education, integrating structured oncofertility counseling into routine oncology care, and ensuring equitable access to preservation services are essential steps toward supporting reproductive rights and improving the long‑term well‑being of young women with cancer.\u003c/p\u003e"},{"header":"Conclusion and recommendations","content":"\u003cp\u003eIt can be concluded that young women have a high level of reproductive concern and intention but a poor level of understanding of infertility preservation. This study revealed that female cancer patients need to be more aware of reproductive issues to maintain their ability to conceive. These findings also suggest that health care providers should tell patients more about the effects of cancer treatment on fertility and the options available for preserving fertility.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eLimitations\u003c/strong\u003e \u003cp\u003eThere were several difficulties in this study, but the main difficulty was financial strain because the majority of the participants did not have enough money, and the high expense of fertility preservation operations was a significant obstacle. The second drawback is that many cases are detected at an advanced stage, and the prognosis for others is not good. Additional restrictions include the need to begin chemotherapy immediately and the fact that half of the participants were unmarried, which made it harder for patients to express a wish for fertility according to Eastern norms. This may also make it more difficult for the researcher to talk to patients about fertility difficulties. Finally, another constraint was the decision-making process, which included family members. The small sample size was caused by several factors, including the length of the questionnaire and the amount of time the researcher spent with each participant in an effort to avoid burdening the patient.\u003c/p\u003e \u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eClinical implications\u003c/h2\u003e \u003cp\u003eIn addition to improving the knowledge and awareness level of oncology females about fertility preservation, this study has a significant impact on convincing patients\u0026rsquo; families and encouraging female patients to perform fertility preservation, as 19/20 females perform fertility preservation. The greatest impact of this study was that the hospital made the decision to preserve fertility for cancer patients at the state's expense. The hospital also bears a portion of the costs, easing the financial burden for females who cannot afford it.\u003c/p\u003e \u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cdiv align=\"Left\"\u003e\n \u003ctable dir=\"rtl\" border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 466px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003eBody Mass Index\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003e(BMI)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 466px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003eDecisional Conflict Scale\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003e(DCS)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 466px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003eFertility Intention Scale\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003e(FIS)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 466px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003eInfertility Knowledge Questionnaire\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003e(IKQ)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 466px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003eMinistry of Science and Technology\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003e(MOST)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 466px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003ePatient decision aids\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003e(PtDAs)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 466px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003eReproductive Concerns after Cancer.\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003e(RCAC)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 466px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003eStatistical Package for the Social Sciences\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003e(SPSS)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor Contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAA and TB conceptualized and designed the study. HM and GA were responsible for data collection and field supervision. AK and AI performed data entry, statistical analysis, and interpretation. MT drafted the initial manuscript. AA and TB critically revised the manuscript for important intellectual content. All authors read and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Scientific Research Ethics Committee, Faculty of Nursing, Assiut University (Approval No. 1120240760). Every participant gave their informed consent to the study. The study was conducted in accordance with the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNot Applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe researchers attest that all pertinent data have been included in the results of this paper. No information was left out of the analyses. The corresponding author has made the datasets used in this investigation accessible.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors affirm that no funding, money, or other assistance was obtained to prepare this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors sincerely acknowledge the cooperation of all the women involved in this study. We also extend our appreciation to the administrative and nursing staff of the study setting for their assistance and support throughout the data collection process.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eMonaco S. SDG 3. Ensure healthy lives and promote well‑being for all at all ages. In: Identity, Territories, and Sustainability: Challenges and Opportunities for Achieving the UN Sustainable Development Goals. Emerald Publishing; 2024. p. 33\u0026ndash;41. doi:10.1108/978183797549520241004.\u003c/li\u003e\n \u003cli\u003eWorld Health Organization. Towards a global action plan for healthy lives and well‑being for all: uniting to accelerate progress towards the health‑related SDGs. Geneva: WHO; 2018. Report No.: WHO/DCO/2018.3. Available from: https://www.who.int/publications/i/item/WHO-DCO-2018.3.\u003c/li\u003e\n \u003cli\u003eHassan A, Golub S. Sexual and reproductive health goals and the 2030 global agenda for sustainable development: progress, prospects, and challenges. J Pediatr Adolesc Gynecol. 2025;38(1):13\u0026ndash;17. doi:10.1016/j.jpag.2024.09.002.\u003c/li\u003e\n \u003cli\u003eDaher‑Nashif S, Bawadi H. Women\u0026rsquo;s health and well‑being in the United Nations sustainable development goals: a narrative review of achievements and gaps in the Gulf States. Int J Environ Res Public Health. 2020;17(3):1059. doi:10.3390/ijerph17031059.\u003c/li\u003e\n \u003cli\u003eMcClam M, Yan R, Su Y, Xiao S, Zhang X. Knowledge, attitude, and behavior towards oncofertility among female breast cancer patients in China. Research Square [preprint]. 2024. doi:10.21203/rs.3.rs‑5427433/v1.\u003c/li\u003e\n \u003cli\u003eHuang S‑M, Kao T‑S, Lien P‑J, Hsieh P‑L, Chen P‑H, Tseng L‑M. Oncofertility care: a qualitative study to understand personal perspectives and barriers in the multidisciplinary breast care team in Taiwan. Women\u0026rsquo;s Health. 2022;18:17455057221078480. doi:10.1177/17455057221078480.\u003c/li\u003e\n \u003cli\u003eLiu K, Nicoletti R, Zhao H, Chen X, Wu H, Leung CH, et al. Young age and adequate BCG are key factors for optimal BCG treatment efficacy in non‑muscle invasive bladder cancer. World J Urol. 2024;42(1):547. doi:10.1007/s00345‑024‑05218‑4.\u003c/li\u003e\n \u003cli\u003eSemler R, Thom B. Fertility preservation: improving access through nurse‑advocated financial assistance. Clin J Oncol Nurs. 2019;23(5):27\u0026ndash;30. doi:10.1188/19.CJON.S2.27‑30.\u003c/li\u003e\n \u003cli\u003eHuang S‑M, Tseng L‑M, Lai JCY, Lien P‑J, Chen P‑H. Infertility‑related knowledge in childbearing‑age women with breast cancer after chemotherapy. Int J Nurs Pract. 2019;25(5):e12765. doi:10.1111/ijn.12765.\u003c/li\u003e\n \u003cli\u003eGorman JR, Pan‑Weisz TM, Drizin JH, Su HI, Malcarne VL. Revisiting the Reproductive Concerns After Cancer (RCAC) scale. Psychooncology. 2019;28(7):1544\u0026ndash;1550. doi:10.1002/pon.5130.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eQiao T‑T, Zheng W, Xing W, Zhang L‑X, Zhang W, Shi Y‑P, Chen X‑J. Psychometric properties of the Chinese version of the Reproductive Concerns After Cancer Scale (RCAC) for young female cancer survivors. Support Care Cancer. 2017;25:1263\u0026ndash;1270. doi:10.1007/s00520-016-3519-1.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eB\u0026aacute;rtolo A, Santos IM, Val\u0026eacute;rio E, Costa A, Reis S, Raposo S, Monteiro S. The European Portuguese version of the Reproductive Concerns After Cancer Scale (RCACS): a psychometric validation for young adult female cancer survivors. Eur J Oncol Nurs. 2020;47:101781. doi:10.1016/j.ejon.2020.101781.\u003c/li\u003e\n \u003cli\u003eToprak F\u0026Uuml;, Uysal N, Turan Z, Akduran F. Fertility Intention Scale in Breast Cancer Survivors: Turkish validity and reliability study. Semin Oncol Nurs. 2025;151894. doi:10.1016/j.soncn.2025.151894.\u003c/li\u003e\n \u003cli\u003eZhu F, Liu C, Qi J, Bian Y, Pang L, Lu Q. Psychometric properties of the Fertility Intention Scale among patients with breast cancer of childbearing age in mainland China. Asia Pac J Oncol Nurs. 2022;9(8):100100. doi:10.1016/j.apjon.2022.100100.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eLi CC, Huang SM, Lai JCY, Hsiung Y, Chen YH, Lee CF. Development and validation of a fertility intention scale in breast cancer survivors. J Nurs Res. 2018;26(3):177\u0026ndash;184. doi:10.1097/jnr.0000000000000223.\u003c/li\u003e\n \u003cli\u003eO\u0026rsquo;Connor AM. Validation of a decisional conflict scale. Med Decis Making. 1995;15(1):25\u0026ndash;30. doi:10.1177/0272989X9501500105.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eGarvelink MM, Boland L, Klein K, Nguyen DV, Menear M, Bekker HL, et al. Decisional conflict scale findings among patients and surrogates making health decisions: part II of an anniversary review. Med Decis Making. 2019;39(4):316\u0026ndash;327. doi:10.1177/0272989X19851346.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eKawaguchi T, Azuma K, Yamaguchi T, Soeda H, Sekine Y, Koinuma M, et al. Development and validation of the Japanese version of the Decisional Conflict Scale to investigate the value of pharmacists\u0026rsquo; information: a before and after study. \u003cem\u003eBMC Med Inform Decis Mak.\u003c/em\u003e 2013;13:50. doi:10.1186/1472-6947-13-50.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eAlsaif RA. Exploring the level of knowledge and attitudes among female cancer patients towards fertility preservation in KSA. Int J Novel Res Healthc Nurs. 2023;10(6):1\u0026ndash;12. doi:10.5281/zenodo.10141918.\u003c/strong\u003e\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eZaami S, Melcarne R, Patrone R, Gullo G, Negro F, Napoletano G, et al. Oncofertility and reproductive counseling in patients with breast cancer: a retrospective study. J Clin Med. 2022;11(5):1311. doi:10.3390/jcm11051311.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eOmani‑Samani R, Vesali S, Navid B, Mohajeri M, Rafsanjani KA, Aghamaleki SZN, et al. Adult cancer patients and parents of younger cancer patients have little information about fertility preservation: a survey of knowledge and attitude. Middle East Fertil Soc J. 2021;26:25. doi:10.1186/s43043-021-00072-5.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eWang Y, Anazodo A, Logan S. Systematic review of fertility preservation patient decision aids for cancer patients. Psycho‑Oncology. 2019;28(3):459\u0026ndash;467. doi:10.1002/pon.4961.\u003c/li\u003e\n \u003cli\u003eRuggeri M, Pagan E, Bagnardi V, Bianco N, Gallerani E, Buser K, et al. Fertility concerns, preservation strategies and quality of life in young women with breast cancer: baseline results from an ongoing prospective cohort study in selected European centers. \u003cem\u003eBreast.\u003c/em\u003e 2019;47:85\u0026ndash;92. doi:10.1016/j.breast.2019.07.006.\u003c/li\u003e\n \u003cli\u003eRuddy KJ, Gelber SI, Tamimi RM, Ginsburg ES, Schapira L, Come SE, et al. Prospective study of fertility concerns and preservation strategies in young women with breast cancer. J Clin Oncol. 2014;32(11):1151\u0026ndash;1156. doi:10.1200/JCO.2013.52.8877.\u003c/li\u003e\n \u003cli\u003eSindi RA, Bagabas MS, Al‑Manabre LM, Alqasmi RZ, Rednah RY, Al‑Jahdali SM, et al. Fertility preservation in cancer patients: evaluation of knowledge, attitude, and practice of health practitioners towards fertility preservation in Makkah region of Saudi Arabia. In: Proceedings of the 1st International Conference on Creativity, Technology, and Sustainability (CCTS 2024). Springer; 2025. p. 509\u0026ndash;520. doi:10.1007/978-981-97-8588-9_48.\u003c/li\u003e\n \u003cli\u003eKo JKY, Cheung CSY, Cheng HHY, Yung SSF, Ng TY, Tin WWY, et al. Knowledge, attitudes and intention on fertility preservation among breast cancer patients. Sci Rep. 2023;13(1):9645. doi:10.1038/s41598-023-36377-w.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Oncofertility, Fertility preservation, Reproductive concerns, Infertility knowledge, Fertility intention, Decisional conflict, Assisted reproductive technology, SDG 3.7","lastPublishedDoi":"10.21203/rs.3.rs-9003906/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9003906/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e One of the greatest concerns for cancer patients of reproductive age is fertility. Numerous studies have demonstrated that patients with cancer lack regular access to fertility preservation information options. This study aimed to evaluate awareness of reproductive concerns for infertility preservation among female cancer patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e A case series study was conducted between March and August 2024 at the gynecological oncology unit in collaboration with the assisted reproductive technology unit at Woman Health Hospital, Assiut University, Egypt. A purposive sample of 20 women aged 16–40 years with newly diagnosed early-stage cancer who had not yet initiated treatment and received fertility counseling was recruited. Data were collected through structured face‒to-face interviews via questionnaires covering personal, obstetrical, reproductive, and cancer-related characteristics, in addition to the Infertility Knowledge Questionnaire, the Reproductive Concerns after Cancer Scale, the Fertility Intention Scale, and the Decisional Conflict Scale. Associations between study variables and participants’ characteristics were examined via appropriate statistical analyses.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e Most women with cancer had poor knowledge about fertility preservation, high reproductive concerns, high fertility intentions and low decisional conflict. There was a highly significant difference between the levels of education, infertility knowledge and infertility intentions (p values \u0026lt;0.001 and \u0026lt;0.041, respectively).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e Mostfemale cancer patients reported high reproductive concerns and strong fertility intentions despite limited knowledge about infertility and fertility preservation. Education level and selected obstetrical factors were significantly associated with infertility knowledge, fertility intentions, and reproductive concerns.\u003c/p\u003e","manuscriptTitle":"Reproductive Concerns and Awareness of Oncofertility Preservation among Female Cancer Patients: Implications for Sustainability","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-02 11:11:47","doi":"10.21203/rs.3.rs-9003906/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-08T05:28:27+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-05T05:57:31+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-29T16:13:25+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"27015172218111845558545883972048093757","date":"2026-03-29T16:06:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"59640438225451494296576689334565221778","date":"2026-03-29T12:13:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"135959361235243769632169579537398569996","date":"2026-03-29T09:57:51+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-29T09:51:06+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-24T09:46:15+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-23T23:25:11+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2026-03-23T23:19:45+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f66d4de2-2d00-427d-9648-319fe0c14725","owner":[],"postedDate":"April 2nd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-07T09:13:04+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-02 11:11:47","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9003906","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9003906","identity":"rs-9003906","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}