Majority of childhood cancer survivors likely to be fertile

Issue: October 10, 2013

Although women who survive childhood cancer were at increased risk for infertility beginning at a young reproductive age, almost two-thirds of them eventually conceived.

Specifically, of the survivors who unsuccessfully tried to conceive for at least 1 year, 64% conceived within 6 months following that first year.

Lisa R. Diller

“Most women think that if they had cancer as a child, then they’ll never have children. It turns out that many of them can get pregnant. It just might be a little harder,” Lisa R. Diller, MD, chief medical officer of Dana-Farber Cancer Institute and Boston Children’s Hospital, said in a press release.

Although The Childhood Cancer Survivor Study has provided information about the adverse effects of cancer therapies on reproductive function, data were lacking on the difficulties of conception in childhood cancer survivors, according to background information in the study.

The analysis by Diller and colleagues included 3,531 women aged 18 to 39 years included in The Childhood Cancer Survivor Study who reported ever being sexually active, as well as 1,366 female sibling controls. Demographic, medical and reproductive information were gathered via questionnaire at baseline. Researchers also assessed the individuals' exposure to alkylating agents and radiation therapy.

Results indicated that childhood cancer survivors were at increased risk for clinical infertility compared with their siblings (RR=1.48; 95% CI, 1.23-1.78).

In addition, the researchers found that infertility was most pronounced during early reproductive years. The RR was 2.92 (95% CI, 1.18-7.20) among those aged 24 years and younger; 1.61 (95% CI, 1.05-2.48) among those aged 25 to 29 years; and 1.37 (95% CI, 1.11-1.69) among those aged 30 to 40 years.

Women treated with alkylating agent chemotherapy or high-dose radiation to the abdomen or pelvis were at most risk for infertility. When compared with sibling controls, survivors were less likely to be prescribed treatment for infertility, despite being just as likely to seek infertility treatment as their siblings (RR=0.57; 95% CI, 0.46-0.70).

Although survivors had an increased time to pregnancy compared with their siblings (P=.032), 64% of 455 survivors with self-reported clinical infertility achieved a pregnancy.

“This is the first study to examine direct questions about infertility and the use of infertility services,” Sara Barton, MD, staff physician at the Heartland Center for Reproductive Medicine and clinical professor at the University of Nebraska Medical School, said in the press release. “Women getting alkylating agents or radiation to the pelvis or abdomen should be triaged for fertility preservation. In addition to being at highest risk to report infertility, female cancer survivors who received those cancer therapies were the least likely to conceive once they had infertility.”

In an accompanying editorial, Richard A. Anderson, MD, PhD, FRCOG, FRCPE, professor of reproductive health at the MRC Center for Reproductive Health at the University of Edinburgh, wrote: “Improved identification of individuals at highest risk and the assessment of both patients’ and treatment factors are necessary for the rational use of fertility-preservation approaches. A few births have been reported in women who had ovarian tissue cryopreserved and later replaced; this approach might be appropriate in girls at high-risk for infertility, but remains experimental. Equally valuable is increased and more accurate provision of information, which should emphasize the need to seek early investigation and treatment for infertility in view of the potential for a reduced ovarian lifespan and uterine compromise.”

For more information:

Anderson RA. Lancet. 2013;doi:10.1016/10.1016/S1470-2045(13)70278-X.
Barton SE. Lancet. 2013;doi:10.1016/S1470-2045(13)70251-1.

Disclosure: The researchers report no relevant financial disclosures.