Abstract
Background Cancer poses significant fertility challenges for women of childbearing age, yet the adoption of fertility preservation(FP) measures remains limited. This study aimed to explore patients’ understanding, attitudes, concerns, psychological well-being, and factors influencing their decisions regarding FP during treatment.

Methods This prospective cohort study involved women aged 18 to 42 diagnosed with non-metastatic breast cancer or lymphoma,treated at the American University of Beirut Medical Center. Patients completed questionnaires at intervals over a2- to 3-year period following diagnosis.

Results Among the 123 women studied, 71.5% were married, and 13.5% had no children. Although 87.8% were informedabout the fertility risks of their treatment, only 45.4% expressed a desire for FP. Multivariable analysis revealed that parity was significantly associated with fertility concerns (p = 0.019). Decisions favoring FP were significantly influenced by younger age at diagnosis, lower parity, and higher education levels (p = 0.001, p < 0.001, and p = 0.036, respectively). While 56% of patients received FP counseling—mostly from oncologists (83%)—the preference for FP methods varied, with 47% choosing medical approaches and 53% opting for procedural interventions. Despite recognizing the importance of FP, 91% reported that it did not significantly influence their treatment choices. Patients showed greater satisfaction when oncologists discussed fertility-related topics (p < 0.001). Over time, overall FertiQoL scores and DASS-42 scores indicated improved psychological well-being.

Conclusion Our study highlights the complexities of FP decisions among cancer survivors, emphasizing the need for proper
counseling to support their quality of life and psychological well-being.