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Motherhood gives meaning to womens lives. Following the introduction of High Activity Antiretroviral Therapy, mother-to-child transmission has been reduced to less than 1%. However, decisions about childbearing are often complex. Generally, women living with HIV (WLHIV) do not feel supported by their healthcare providers and are pressured by family and communities to give up on the idea of having children. Therefore, there is a need to examine reproductive decision-making issues among WLHIV to empower them and develop safer and effective evidence-based care using a person-centered approach. This study aims to interpret the process of reproductive decision-making among WLHIV. A metasynthesis of qualitative evidence was conducted following the PRISMA guidelines. Four pairs of reviewers independently screened the studies meeting the inclusion criteria achieving a 95% of agreement. Research quality was assessed using the Critical Appraisal Skills Programme. From 4168 articles identified, only 18 were finally included. Three major themes emerged from the data as factors that influence the complex process of reproductive decision-making in WLHIV: Shattered identity, Challenges, and Coping and Resilience. There is a need for an integrated care and a comprehensive multidisciplinary counselling approach. More training and resourdes are required in order to provide better person-centered and cultural competent care.