Fertility-related distress and female identity reconstruction among reproductive-age women with breast cancer in China: a qualitative study

Abstract

Breast cancer is increasingly diagnosed among Chinese women of childbearing age. Cancer treatments carry variable gonadotoxic risks that participants feared could lead to lasting reproductive impairment, triggering widespread fertility-related distress closely intertwined with female identity.Insufficient clinical fertility preservation information further exacerbates patients’ psychological burden. Existing studies are dominated by quantitative designs, with limited culturally contextualized qualitative evidence on fertility distress and identity experiences in Chinese reproductive-age women diagnosed with breast cancer. Notably, most existing oncofertility research focuses on clinical reproductive interventions, while localized qualitative studies exploring Chinese patients’ fertility-related psychological struggles remain scarce. To explore Chinese reproductive-age women’s lived experiences of fertility-related distress and the subjective meaning of fertility worries to their sense of self. A qualitative descriptive interview study was conducted with 25 reproductive-age women diagnosed with breast cancer. Data were analyzed using Graneheim and Lundman’s systematic inductive qualitative content analysis. Phenomenological bracketing was used before coding as a reflexive measure, rather than as a primary analytical framework. Semi-structured interviews were conducted in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ), with all required COREQ methodological details thoroughly described in the Methods section; the standardized semi-structured interview guide is available as Supplementary File 2. Four core inductive themes were identified from participant narratives: multidimensional fertility-related distress aggravated by inadequate fertility preservation literacy; subjective interconnection between fertility distress and participants’ subjectively lowered self-worth formed under prevailing maternal norms; multifaceted individual, familial and medical coping dilemmas; andfour recurring, dynamically interwoven processes of identity reconstruction, including expectation adjustment, self-value remodeling, post-traumatic growth, and multidisciplinary support-seeking. Fertility-related distress reported by these participants carries distinct cultural characteristics, and participants subjectively described intertwined reproductive worries and diminished self-worth. Multiple barriers including traditional reproductive normative expectations and insufficient standardized fertility preservation education hinder long-term psychological recovery. The findings suggest that participants may benefit from early stratified fertility counseling and culturally responsive psychosocial support services tailored to their reproductive circumstances. Further quantitative clinical research is needed to verify the effectiveness of such multidisciplinary supportive pathways for this patient group.