Reproductive Outcomes for Survivors of Childhood Cancer

Abstract

Due to remarkable progress in therapy for pediatric cancer, long-term survival is expected for 80% of children and adolescents diagnosed with cancer. Infertility remains one of the most common and life-altering complications experienced by adults treated for cancer during childhood. Surgery, radiation, or chemotherapy that negatively affects any component of the hypothalamic-pituitary-gonadal axis may compromise reproductive outcomes in childhood cancer survivors. The risk of infertility is generally related to the tissues or organs involved in cancer and the specific type, dose, and combination of cytotoxic therapy. In addition to anticancer therapy, age at treatment, sex, and likely genetic factors influence the risk of permanent infertility. When possible, contemporary protocols limit cumulative doses of cytotoxic therapy in an effort to optimize reproductive potential. If sterilizing therapy is required for cancer control, fertility preservation measures should be explored before initiation of therapy. For childhood cancer survivors who maintain fertility, health risks to offspring resulting from their cancer treatment are major concerns. Radiation affecting ovarian and uterine function has been linked to pregnancy complications including spontaneous abortion, preterm labor, fetal malposition and low birth weight. The risk of congenital malformations, genetic disorders, and cancer appears to be low, with the exception of cancer risk in offspring born to survivors with germline cancer-predisposing mutations. This review will summarize research about cancer treatment factors impacting fertility and pregnancy outcomes of childhood cancer survivors. The data presented should facilitate the delivery of preventive counseling and age- and gender-appropriate interventions to optimize reproductive outcomes in childhood cancer survivors.

AMH/MIS as a contraceptive that protects the ovarian reserve during chemotherapy

“…One of the significant causes of POI is chemotherapy. Chemotherapy, particularly for childhood cancers (27,28) and for cancers that affect women of reproductive age such as breast cancer (29), can have lasting effects on female fertility. In the breast cancer population alone in the United States the NIH estimates 246,660 women were diagnosed with breast cancer in 2016, of which 10.7% were under age 45, and a majority of which received potentially fertility-impairing treatments consisting of regimens of chemotherapy that include alkylating agents, doxorubicin (DOX), and taxanes (29).…”

Endocrine late sequelae in long-term survivors of childhood non-Hodgkin lymphoma

“…Infertility has been frequently reported in childhood cancer survivors [21][22][23]. Additionally, low AMH or inhibin B levels, which are fertility markers, have been reported [24,25].…”

Faisabilité de la congélation embryonnaire dans la préservation de la fertilité féminine

“…Les é tudes de cohortes des enfants né s de mè res aux anté cé dents de traitement anticancé reux sont cependant rassurantes et ne montrent pas d'augmentation du risque d'anomalies chromosomiques ni d'anomalies congé nitales [37][38][39]. Cependant, dans l'é tude de Signorello et al, ces patientes pré sentent un risque d'avoir un enfant pré maturé multiplié par deux ; ce risque é tant encore plus important en cas d'anté cé dent d'irradiation uté rine, avec 50 % d'enfants pré maturé s et 18,2 % de restriction de croissance (< 108 percentile) [40].…”