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Female survivors of childhood cancer: infertility, infertility treatment, and achievement of pregnancy


Previous studies have shown decreased pregnancy rates and early menopause in female cancer survivors; however, infertility rates and reproductive interventions have not been studied.
A study has investigated infertility and time to pregnancy in female childhood cancer survivors, and analysed treatment characteristics associated with infertility and subsequent pregnancy.

The Childhood Cancer Survivor Study ( CCSS ) is a cohort study including 5 year cancer survivors from 26 Canadian and US institutions who were younger than 21 years at the time of diagnosis between Jan 1, 1970, and Dec 31, 1986, and a sibling control group.

Investigators included women aged 18-39 years who had ever been sexually active, and gathered demographic, medical, and reproductive data via a baseline questionnaire, and quantified exposure to alkylating agents and radiation therapy.
Self-reported infertility, medical treatment for infertility, time to first pregnancy in survivors and siblings, and the risk of infertility in survivors by demographic, disease, and treatment variables were analysed.

3531 survivors and 1366 female sibling controls who enrolled between Nov 3, 1992, and April 4, 2004, were included.

Compared with their siblings, survivors had an increased risk ( relative risk, RR=1.48; p less than 0.0001 ) of clinical infertility ( ie, greater than 1 year of attempts at conception without success ), which was most pronounced at early reproductive ages ( RR=2.92, p=0.020, in participants less than or equal to 24 years; 1.61, p=0.029, in those aged 25-29 years; and 1.37, p=0.0035, in those aged 30-40 years ).

Despite being equally likely to seek treatment for infertility, survivors were less likely than were their siblings to be prescribed drugs for treatment of infertility ( 0.57, p less than 0.0001 ).

Increasing doses of uterine radiation and alkylating agent chemotherapy were strongly associated with infertility.

Although survivors had an increased time to pregnancy compared with their siblings ( p=0.032 ), 292 ( 64% ) of 455 participants with self-reported clinical infertility achieved a pregnancy. ( Xagena )

Barton SE et al, The Lancet Oncology 2013; 14: 873-881

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