Considerations of breast cancer survivors to return for embryo transfer after fertility preservation: A qualitative study

•First qualitative research of considerations of women after fertility preservation.•Women are strongly motivated to try natural conception after fertility preservation.•Perceived time pressure is an important motivator for embryo transfer.•Wish for pre-implantation genetic testing is a reason for embryo transfer.•Physician’s advice highly influences the decision on mode of conception. To gain insight into the considerations of breast cancer survivors to return or not for embryo transfer after the use of fertility preservation. This is a qualitative study with semi-structured interviews. The interviews were planned until saturation of themes had been achieved. Content analysis was used to analyze the data. Sixteen out of 35 approached women took part in this study. Interviews were conducted with women who had oocytes or embryos cryopreserved prior to breast cancer treatment at the Maastricht University Medical Center between 2008 and 2016. All women who had cryopreservation more than two years ago were invited for the interviews. Women who had recurrence of disease were excluded. In the interviews we hypothesized the situation ‘suppose the menses would have been recovered completely’ for women who still had chemotherapy-induced menopause or used an GnRH (Gonadotropin-releasing hormone) analogue. Most women had a strong intrinsic motivation to pursue natural conception over the use of earlier cryopreserved oocytes or embryos. Time pressure was the most mentioned consideration to use cryopreserved oocytes or embryos. The wish to use pre-implantation genetic testing (PGT) in the presence of a germline BRCA1/2 mutation was another consideration to opt for embryo transfer. Furthermore, the physician’s advice was an important motivation to choose for either natural conception or the use of cryopreserved oocytes or embryos. Multiple considerations influence women’s decision making on the mode of conception after breast cancer. Although it concerned a single-center study in a highly-selected population, insight into these considerations can help physicians to address these important topics in counseling these women.