Reproductive intentions in childless adolescent and young adult female cancer survivors

Abstract

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.

Family size and duration of fertility in female cancer survivors: a population-based analysis

“…There are additionally several other factors that influence the likelihood of pregnancy after cancer, including effects on rates of cohabitation/marriage, sexuality, and the impact of other long-term health consequences (generally termed ''late effects'') of cancer treatment (18)(19)(20)(21)(22)(23). Concerns regarding health status and disease recurrence may also be significant in decisions regarding family building after treatment (24); others may be voluntarily childless (25). Thus, there is a complex interplay of biologic, psychologic and social factors that determine postcancer fertility (26).…”

Attitudes and Perceptions of Parenthood Among Young Adult Survivors of Childhood Cancer

“…Reasons for not wanting children remain poorly understood among childhood cancer survivors and voluntary childlessness needs more research attention. 36 Fifth, our overall response rate was 52%, which may be regarded as acceptable, although participating in two surveys may have introduced some selection bias. Finally, we were unable to examine gonadotoxicity in relationship to parenthood attitudes.…”

Lower female partner live birth rate in male cancer survivors: An age‐matched cohort analysis of the Utah Population Database

“…There are likely other under‐recognised factors that compromise fertility potential in men with a cancer diagnosis. Fertility intentions likely vary by age, with older male cancer survivors having lower desire to have children, as shown in data from female cancer survivors (van Dijk et al, 2018; Lam et al, 2020). It is also established that childhood cancer survivors are more likely to be never married compared to siblings and the United States population, which may impact fertility intentions (Janson et al, 2009).…”