Pregnancy Desire and Pregnancy Attempt: Why Words Matter in Reproductive Research -- A Nationwide cross-sectional Cohort Study

ObjectiveTo quantify the gap between pregnancy desire and pregnancy attempts among young women with and without a history of breast cancer (BC), and to identify factors associated with this gap. DesignCross-sectional cohort study. SettingThe FEERIC study, conducted in France. PopulationWomen aged 18-43 years without or with prior BC filling inclusion forms of a collaborative study. MethodsPregnancy desire was assessed by self-report ("Do you currently desire a pregnancy?"). Attempt was defined as engaging in unprotected intercourse with the intention to conceive. The pregnancy desire-attempt gap was defined as expressing a desire for pregnancy without actively trying to conceive. Logistic regression was used to evaluate associated demographic, clinical, and treatment-related factors. Main outcome measuresPrevalence of the pregnancy desire-attempt gap and predictors of this gap among BC survivors. ResultsOf 4,351 participants (517 with BC and 3,834 controls), 735 (16.9%) reported a pregnancy desire with 54% attempting conception and 46% who did not. The desire-attempt gap was significantly more frequent in women with a history of BC (OR=1.62, 95%CI[1.15-2.30]). Among BC survivors, younger age (<30years), nulliparity, being single, and ongoing endocrine therapy were independently associated with the gap, whereas prior chemotherapy or trastuzumab were not. ConclusionsNearly half of women declaring desiring pregnancy do not initiate pregnancy attempts, with a larger gap among BC survivors. These findings highlight the need to explore both medical barriers and psychosocial determinants underlying this gap and underscore the importance of refining the language used in reproductive research. FundingThis study was supported by "SHS INCa" grant no.2016-124 and is part of a research project on young women funded by Monoprix*.