The Impact of Fertility Preservation Interventions on Fertility Decision Making in Patients With Breast Cancer: A Systematic Review

BACKGROUND: Clinical evidence guiding the fertility decisions of reproductive-age patients with breast cancer remains limited. No study has reported the impact of fertility preservation interventions on the decision-making process of patients with breast cancer. Fertility preservation interventions reduce fertility decision-making conflicts and address psychological issues in patients with breast cancer. AIMS: We evaluated the effectiveness of fertility preservation interventions, including educational materials, decision aids, and counseling models in facilitating informed fertility-related decision-making among reproductive-age patients newly diagnosed with breast cancer. Additionally, we examined the influence of these interventions on patients' psychological state. METHODS: We searched PubMed, Embase, ClinicalTrials.gov, and the Cochrane Library from inception to February 20, 2025. Randomized controlled trials and non-randomized controlled trials that reported the effects of fertility preservation interventions on fertility decision making among patients with breast cancer were included. Two authors independently screened the studies, assessed their quality, and extracted the data. Bias risk was assessed using the Cochrane risk-of-bias tool for randomized trials. RESULTS: The interventions were categorized as decision aids, educational interventions, and psychological interventions. CONCLUSIONS: Fertility preservation interventions significantly enhanced the fertility knowledge of patients with breast cancer, particularly interventions such as decision aids. However, no single intervention demonstrated distinct superiority specifically in terms of mitigating decisional conflict and alleviating patients' psychological distress. Fertility preservation interventions, when combined with specialist consultation, enhanced fertility-related knowledge and had a positive impact on fertility decision making. High-quality research is recommended to enrich fertility preservation interventions and encourage multidisciplinary teamwork to enhance fertility decision-making. TRIAL REGISTRATION: The protocol was registered on PROSPERO (Registration number: CRD420251007625).