Abstract Context Many female survivors of adolescent and young adult cancers (AYA survivors) have shortened reproductive lifespans. However, the timing and duration of ovarian function after cancer treatment are largely unknown. Objective To model the trajectory of ovarian function over two decades following cancer treatment and evaluate how trajectories vary by treatment gonadotoxicity and age. Design In a prospective cohort, AYA survivors aged 18-39 at variable times since cancer treatment completion provided dried blood spots (DBS) every 6 months for up to 18 months. Anti-Müllerian hormone (AMH) levels were measured using the Ansh DBS AMH enzyme-linked immunosorbent assay. The mean AMH trajectory was modeled for the entire cohort and separately by treatment gonadotoxicity and age using functional principal components analysis. Results 763 participants, mean (standard deviation) enrollment age 33.3 (4.7) and age at cancer diagnosis 25.9 (5.7) years, contributed 1905 DBS samples. The most common cancers were breast (26.9%), lymphoma (24.8%), and thyroid (18.0%). AMH trajectories differed among survivors by treatment gonadotoxicity (low, moderate, or high) (P < 0.001). Following low or moderately gonadotoxic treatments, AMH levels increased over 2-3 years and plateaued over 10-15 years before declining. In contrast, following highly gonadotoxic treatment, AMH levels were lower overall and declined shortly after peak at 2-3 years. Younger age at treatment was associated with higher trajectories, but a protective effect of younger age was not observed in survivors exposed to highly gonadotoxic treatments (Pinteraction < 0.001). Conclusions In this large AYA survivor cohort, timing and duration of ovarian function strongly depended on treatment gonadotoxicity and age at treatment. The findings provide novel, more precise information to guide reproductive decision-making.

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Objective: To estimate the association between perceived fertility potential and contraception use and to characterize factors important in contraceptive decision making in reproductive-age, female cancer survivors. Design: Cross-sectional study. Setting: Participants were from two state cancer registries, physician referrals, and cancer survivor advocacy groups in the United States. Patient(s): A total of 483 female survivors aged 18-40 years. Intervention(s): Online questionnaire. Main Outcome Measure(s): Contraception use. Result(s): Eighty-four percent of participants used contraception; 49.7% used highly effective, World Health Organization tiers I and II methods (surgical sterilization, intrauterine devices, contraceptive implant, combined hormonal contraceptives, medroxyprogesterone acetate, progestin-only pills, contraceptive diaphragm). Contraception non-use was more common among survivors who perceived themselves to be infertile, compared with survivors who perceived themselves to be as or more fertile than similarly aged peers (prevalence ratio 4.0, 95% confidence interval 2.5-7.4). In mediation analysis that adjusted for clinical infertility, 59% of the association between prior chemotherapy and contraception non-use was explained by perceived infertility. Contraception efficacy (n ¼ 62, 25.8%) and ease of use (n ¼ 50, 20.8%) were the most cited reasons for using tier I/II methods; compared with lack of hormones (n ¼ 81, 49.7%) as the predominant reason for using less-effective, tier III/IV methods. Conclusion(s): Although female, reproductive-age cancer survivors had high uptake of contraception, those who perceived themselves to be infertile were less likely to use contraception. Throughout survivorship, clinicians should counsel survivors on fertility potential in the context of their prior cancer treatments and on factors, including contraceptive efficacy and hormone-free contraception, that inform reproductive decision making in this population. (Fertil Steril Ò 2019;111:763-71. Ó2019 by American Society for Reproductive Medicine.) El resumen está disponible en Español al final del artículo.

Female young adult cancer survivors were significantly more likely to use emergency contraception compared with the general population. Populations including nonwhite survivors have a higher risk, suggesting differences in family planning care. Strategies to improve contraception and decrease the need for emergency contraception are needed.

OBJECTIVE: Reproductive decisions are complex for cancer survivors, yet little is known about factors related to survivors' reproductive intentions. As chronic disease and disease burden are related to voluntary childlessness in other populations, we tested the hypothesis that cancer treatments and comorbidities are associated with lower desire to have children in female adolescent and young adult (AYA) cancer survivors who are childless. DESIGN: Cross-sectional. MATERIALS AND METHODS: Female AYA survivors recruited to the Reproductive Window study on ovarian function completed a web-based questionnaire on desire for future children and demographic, cancer, and reproductive characteristics. Participants were ages 18-40, diagnosed with cancer as AYA (aged 15-35), completed primary cancer treatments, and had at least one ovary. The cohort was restricted to nulliparous participants (n¼537). The primary exposures were cancer treatments and comorbidities. The primary outcome was no desire for future children, assessed by questions from the National Survey for Family Growth. Logistic regression models were used to test associations between participant characteristics and voluntary childlessness, adjusting for confounding. RESULTS: Mean participant age was 31.5AE5.2 years, 72% identified as Caucasian, 23% as Hispanic, and the most common cancers were breast (22%), thyroid (20%), and Hodgkin lymphoma (19%). 9.1% of participants self-identified as a gender and sexual minority (GSM). Overall, 22% did not desire future children. In multivariable analysis, prior chemotherapy, radiation, surgery, comorbidities and cancer type were not significantly associated with reproductive intention. Survivors of older reproductive age and GSM identification were more likely to report not desiring future children. Survivors with a history of infertility were more likely to desire children in the future (Table). CONCLUSIONS: Nearly one-quarter of childless female AYA cancer survivors do not desire to have children in the future. Similar to the general population, survivors of older age and GSM identity were more likely to report the intention not to have children in the future. Contrary to our hypothesis, cancer treatment exposures and increasing number of co-morbidities were not associated with voluntary childlessness, demonstrating the need for fertility and pregnancy care across this population, regardless of prior treatment.