Infertility, infertility treatment, and achievement of pregnancy in female survivors of childhood cancer: A report from the Childhood Cancer Survivor Study cohort Journal Article


Authors: Barton, S. E.; Najita, J. S.; Ginsburg, E. S.; Leisenring, W. M.; Stovall, M.; Weathers, R. E.; Sklar, C. A.; Robison, L. L.; Diller, L.
Article Title: Infertility, infertility treatment, and achievement of pregnancy in female survivors of childhood cancer: A report from the Childhood Cancer Survivor Study cohort
Abstract: Background: Previous studies have shown decreased pregnancy rates and early menopause in female cancer survivors; however, infertility rates and reproductive interventions have not been studied. We investigated infertility and time to pregnancy in female childhood cancer survivors, and analysed treatment characteristics associated with infertility and subsequent pregnancy. Methods: 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. We included women aged 18-39 years who had ever been sexually active. We 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. Findings: 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 [95% CI 1·23-1·78]; p<0·0001) of clinical infertility (ie, >1 year of attempts at conception without success), which was most pronounced at early reproductive ages (RR 2·92 [95% CI 1·18-7·20], p=0·020, in participants ≤24 years; 1·61 [1·05-2·48], p=0·029, in those aged 25-29 years; and 1·37 [1·11-1·69], 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 [95% CI 0·46-0·70], p<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. Interpretation: A more comprehensive understanding of infertility after cancer is crucial for counselling and decision making about future conception attempts and fertility preservation. Funding: National Cancer Institute, American Lebanese Syrian Associated Charities, Swim Across America. © 2013 Elsevier Ltd.
Keywords: adolescent; adult; cancer survival; child; controlled study; child, preschool; survival rate; young adult; major clinical study; united states; cancer radiotherapy; brain radiation; follow-up studies; neoplasms; cohort studies; cohort analysis; risk factors; alkylating agent; childhood cancer; infertility; self report; questionnaires; siblings; survivors; whole body radiation; infant; infant, newborn; pregnancy; sibling; canada; uterus; female infertility; infertility therapy; abdominal radiotherapy; hypophysis; pelvic radiotherapy; achievement; gonad dose; time to pregnancy; pregnancy rate
Journal Title: Lancet Oncology
Volume: 14
Issue: 9
ISSN: 1470-2045
Publisher: Elsevier Science, Inc.  
Date Published: 2013-08-01
Start Page: 873
End Page: 881
Language: English
DOI: 10.1016/s1470-2045(13)70251-1
PROVIDER: scopus
PUBMED: 23856401
PMCID: PMC3845882
DOI/URL:
Notes: --- - "Export Date: 4 September 2013" - "CODEN: LOANB" - "Source: Scopus"
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  1. Charles A Sklar
    322 Sklar