Observational studyBMC medical ethics2026
Attitudes of healthcare providers towards fertility preservation in Portugal: perceived support across indications and their ethical implications.
Observational study in BMC medical ethics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundHealthcare providers (HCPs) play a pivotal role in shaping access to and ethical deliberation around fertility preservation. While fertility preservation due to oncological and non-oncological diseases is widely accepted, its use for other reasons, such as career development, gender transition, or military deployment, raises ethical and professional questions. This study aimed to explore the attitudes of HCPs in Portugal towards fertility preservation across different indications and to identify professional factors associated with variations in perceived support.
methodsWe conducted a cross-sectional observational study using an anonymous online questionnaire administered via Lime Survey between October 2024 and March 2025. A total of 298 HCPs working in Portugal were recruited through judgment sampling. Data on HCPs' level of agreement with the use of fertility preservation for eight indications, as well as on their sociodemographic and professional characteristics, were collected. Descriptive analyses and bivariate comparisons were performed to explore levels of support and associated factors.
resultsSupport for fertility preservation was highest for cancer (96.3%), infertility (93.3%), benign diseases (91.3%), prevention of genetic diseases (86.3%), and age-related fertility loss (79.8%). In contrast, lower levels of support were observed for gender transition (50.7%), career development (44.3%), and active military service or deployment (41.9%), with approximately one-third of participants expressing neither agree nor disagree positions. Attitudes towards these ethically more contested indications were significantly associated with professional characteristics, including involvement with peers and patients, occupation group, working setting, and years of experience.
conclusionHCPs in Portugal show strong support for fertility preservation in diseases contexts but reveal ambivalence regarding its use for gender transition, career development, and military purposes. This variability reflects ongoing attitudinal uncertainty and suggests that professional experience and clinical context may influence ethical positioning. Targeted educational and ethical reflection initiatives may help support HCPs in addressing the ethical, social, and technical complexities associated with fertility preservation across different contexts.
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