Many women may not receive adequate information about RHRs or FP at the time of cancer diagnosis. Advancements in reproductive technology and emerging organizations that cover financial costs of FP have dramatically changed what options women have to preserve their fertility. Routine and thoughtful RHR and FP counseling, as well as collaborative cancer care will help ensure that women diagnosed with cancer are provided with the services and information they need to make an informed choice about their reproductive future.

Background:Little is known about how to predict post-treatment reproductive health outcomes in reproductive-age women with cancer. We sought to determine whether predictors like age, parity, temporary post-treatment amenorrhea, or posttreatment infertility are associated with reproductive compromise. Methods: We contacted 2532 women from a statewide cancer registry (randomly sampled; diagnosed from 1993-2007; ages 18-40 at diagnosis) with a history of chemotherapy treatment for leukemia, lymphoma, breast and gastrointestinal GI) cancers. Using a written and electronic survey, we evaluated outcomes including temporary amenorrhea, permanent amenorrhea, infertility, and early menopause (age < 45). Logistic regression was used to determine the probability of amenorrhea and infertility, based on clinical predictors. Censored data methods were used to determine the probability of early menopause. Results: Out of 1041 responders, 620 women who received chemotherapy alone were included in the analysis of reproductive compromise. One-third noted menses had ceased during or immediately after treatment and one-half of these women noted a subsequent return of menstruation. Temporary amenorrhea post-treatment -but not duration of amenorrhea -predicted a trend toward increased rates of infertility (adjusted odds ratio (AOR) 2.2, 95% CI 1.0-4.8). Post-treatment infertility was significantly associated with an increased risk for earlier menopause (p<0.05 compared to those who did conceive). Conclusions: In this population, clinical metrics including a history of post-treatment amenorrhea and/or infertility appeared to predict risk of future reproductive impairment. These parameters could be used to develop guidelines for triage to reproductive health specialists in women with curable malignancies for whom chemotherapy is recommended.

The purpose of this study was to characterize reproductive concerns among female cancer survivors and determine the role of targeted counseling in improving overall reproductive quality of life (QOL). A survey was administered to women from the California Cancer Registry, ages 18-40, with nongynecologic cancers diagnosed from 1993 to 2007, who received fertility-compromising treatments. In total, 356 women completed the survey, which included questions regarding their reproductive health counseling history and the reproductive concerns scale (RCS), a validated reproductive QOL tool. Factors independently associated with higher RCS scores included a desire for children at the time of diagnosis, posttreatment infertility, treatment with chemoradiation or bone marrow transplant, and income less than $100,000 per year at diagnosis. Among the highest reported reproductive concerns were those related to loss of control over one's reproductive future and concerns about the effect of illness on one's future fertility. Across our population and independent of age, in-depth reproductive health counseling prior to cancer treatment was associated with significantly lower RCS scores. Our findings highlight the importance of early counseling and targeting high-risk groups for additional counseling after completion of cancer treatment. This approach may be an effective strategy for optimizing long-term reproductive QOL in this vulnerable population.

Placental malperfusion, rather than inflammation, was more commonly associated with preterm births in women with uterine anomalies.