Young female cancer patients seem to value the opportunity to make a decision about FP [33, 36]. These patients report the desire to receive as much information about fertility treatments and FP interventions as possible around the time of the diagnosis so they can play an active role regarding this decision [33]. This is particularly important because studies reveal that more informed patients who have the opportunity to make a decision about FP together with health professionals have lower decisional-conflict levels [24, 33], make higher-quality decisions [33], have greater satisfaction with their care after the decision [24], and have better psychological adjustment to the diagnosis [33] than patients who are less informed and do not have the opportunity to be part of this decision-making process. A study by Peate and colleagues [33] that evaluated women with breast cancer of reproductive age (21–40 years old) reported that a lack of information increases anxiety and negatively influences the quality of the decision-making experience. However, this study also revealed that the presence of anxiety levels in female breast cancer patients do not appear to be correlated with their fertility knowledge or with their desire for information, suggesting that fertility-related information should be provided to all women regardless of their emotional well-being.

Results on the motivations for parenthood among female cancer survivors and the impact of cancer-related infertility and of the FP decision in these women’s psychological adaptation in survivorship suggest the key role of the FP decision before cancer treatment in these women’s lives.

Research reveals that female cancer survivors have more positive motivations for childbirth than healthy women do (e.g., [48]). Despite the fear of a cancer recurrence after a pregnancy, these survivors associate having a child with happiness and a fulfilling life [18], value the family, and feel very competent to educate a child [41]. Through a systematic literature review, Gonçalves et al. [21] reported that childbearing seems to be an important issue for young female breast cancer survivors, even for those who are against having children after cancer due to the potential risks associated with some types of tumors.

The diagnosis of cancer-related infertility has been shown to have a negative impact on the individual adaptation of these survivors in terms of the experience of high levels of anxiety [28, 41], depression [8], sexual dysfunction [9, 37], disruptions to intimate relationships [37], and feelings of loss and anger [37, 40]. Moreover, infertile survivors also must address menopausal symptoms, such as vaginal dryness and hot flashes, which can have a negative impact on their quality of life [9]. Some female cancer survivors even describe the experience of being infertile as being as painful as the cancer diagnosis itself [18]. According to results reported by Canada and Schover [5], social parenting (i.e., adoption) does not completely resolve this distress.

Young adult female cancer survivors evaluate the opportunity to make a decision about FP before the cancer treatments as important because this experience can make them feel positive, peaceful, happy, and hopeful and can give them a reason to live [20, 47]. Many survivors report that one good thing about FP is that it is one of the few decisions that they can make themselves; it allows them to feel in control of an uncontrollable situation [20]. Furthermore, this decision-making process seems to have a positive impact on the adaptation of these female patients in survivorship. Letourneau and colleagues [26] preformed a retrospective study with 1041 female cancer survivors of reproductive age (18–40 years old) who had previously submitted to fertility-threatening treatments and found higher levels of life satisfaction and quality of life and lower levels of regret in relation to the FP decision in women who were counseled by a specialist in reproductive medicine about FP before cancer treatments than in women who did not receive this consultation. These results were found regardless of the decision of the female patients about FP.

Despite the importance that the decision-making process about FP seems to have for young female cancer patients, these women note significant gaps in the information provided by their oncologists about the risks of a pregnancy in survivorship, the infertility risk associated with cancer treatments and possibilities to spare their fertility [4]. Moreover, the literature reveals a lack of or delayed referral of these patients to a fertility specialist consultation to make a decision about the preservation of their fertility (e.g., [20]). These two factors can prevent these patients from having a choice in this matter [4] because these cancer patients cite their oncologists as a critical source of support and information in the cancer diagnosis and treatment process [36]. The literature has also reported the key role of written information and web-based tools in the improvement of FP decision-making outcomes [34, 42].

Taking this situation into account, the guidelines for intervention of several oncology societies around the world (e.g., the American Society of Clinical Oncology, Clinical Oncology Society of Australia [COSA], European Society for Medical Oncology, the European Society of Breast Cancer Specialists) emphasize the responsibility of all health professionals in oncology to inform all cancer patients about the risk of cancer treatment-related fertility and to refer them in a timely manner to a specialist in reproductive medicine to make a decision about FP [7, 12, 27, 35]. Specifically in Portugal, updated and general guidelines for intervention in oncology, with recommendations for the discussion with young adult cancer patients about their reproductive future, are needed (i.e., the existing guidelines are from 2009 and are specific to breast cancer patients; [15]).

The PCFP provides reproductive monitoring and counseling to female cancer patients from all over the country who are planning to undergo treatments that may threaten their fertility.

These patients can be referred to the PCFP by their oncologists or can ask for a consultation. Regardless of the situation, the first appointment at the center is scheduled in the 24–48 h following the request.

In their first visit to the PCFP, female cancer patients are supported in making a decision about FP. They undergo (1) a medical appointment with a specialist in reproductive medicine, where they are informed about the available FP options in terms of medical procedures involved, costs, risks, and success rates, and the adequacy of each method to each situation is discussed, taking into account sociodemographic, clinical, and reproductive variables; (2) medical exams to assess their baseline reproductive function; and (3) an appointment with the psychologist. The psychologist plays an important role in this process because this health professional assesses the psychological adaptation of the patient to the recent cancer diagnosis, the patient’s attitudes toward the risk of future infertility, and their understandings and expectations of FP and discusses the pros and cons of each FP option (this appointment is also important to identify information that needs to be better clarified by the oncologist or the specialist in reproductive medicine). This process is always performed in collaboration with the patient’s oncologist, which is essential to ensure that the decision about FP does not interfere with the cancer treatments. In this first visit to the center, the amount of time the patient has to make the final decision is defined, taking into account several variables, such as the date provided by the oncologist for the beginning of the gonadotoxic cancer treatments.

If the patient, together with the health professionals involved, decides to preserve her fertility, the next step is to perform the chosen technique. It is important to note that throughout the medical procedures involved, medical and psychological support is provided to patients according to their needs.

After this process, all patients are followed up regardless of whether they preserve their fertility. First, during the cancer treatments, the patients’ follow-up is performed by phone calls made by the psychologist of the team every 6 months. These are important opportunities for the PCFP team to stay updated about the clinical situation of the patients and for the patients to maintain contact with the team that is available to support their reproductive decisions in the future. These phone calls are also important to provide emotional support and to identify patients in need of regular appointments with a psycho-oncologist. Second, after the completion of the cancer treatments, the patients are followed through visits to the PCFP every 6 months. As in the first visit to the center, in these follow-up visits, the patients undergo (1) a medical appointment where they are counseled about their reproductive health and decisions (e.g., the possibility of becoming pregnant naturally, the use of cryopreserved material in case of previous FP, implementation of assisted reproduction techniques [ART]); (2) medical exams to monitor their reproductive function after the cancer treatments and to assess the impact of the cancer treatments in ovarian function, taking into account the baseline assessment of the first visit to the PCFP; and (3) an appointment with the psychologist. The psychologist plays an important role in this process because this health professional assesses the patients’ psychological adaptation to survivorship, their understandings and attitudes toward survivorship, and their expectations and plans about their parental project, provides emotional support in case of an infertility diagnosis, and supports decisions regarding the use of the cryopreserved material to achieve pregnancy (in case of previous FP) and attitudes about ART and even third-party techniques and adoption. It is important to note that the goals of each medical and psychological appointment in the follow-up phase are variable according to each patient, taking into account the patient’s sociodemographic, reproductive, and clinical variables.