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Fertility after cancer: separate studies give cause for concern, optimism

29 July 2013
Appeared in BioNews 715

Despite treatment for childhood cancer causing an increased risk of infertility, most women still manage to conceive, research has shown. Although it took longer on average, 64 percent of former cancer patients managed to become pregnant.

Patients surviving childhood cancer were 48 percent more likely to be affected by 'clinical infertility', defined as unsuccessfully attempting to conceive for a year or longer. This risk was particularly increased in younger women.

High dose chemotherapy with alkylating agents, or pelvic radiotherapy additionally increased the risk of infertility.

Researchers from Brigham and Women's Hospital and the Dana-Farber/Boston Children's Cancer and Blood Disorders Center, USA, used a large childhood cancer study to compare pregnancy rates between 3,500 women affected by childhood cancer to 1,300 of their sisters.

'Most women think that if they had cancer as a child, then they'll never have children. It turns out that many of them can get pregnant. It just might be a little harder', said lead author Dr Lisa Diller. 'Women who have a history of childhood cancer treatment should consider themselves likely to be fertile. However, it might be important to see an expert sooner rather than later if a desired pregnancy doesn't happen within the first six months'.

Cancer treatment has become more effective and IVF uptake has increased since the study began in 1992, meaning the risk of infertility is lower for today's young cancer patients. However, alkylating agents and pelvic radiotherapy are still in clinical use, so this report's findings are still applicable.

The importance of such research is highlighted by another recent publication which showed that many women who had childhood cancer were dissatisfied with how the impact of their treatment on their fertility was discussed with them.

Patients of both sexes were surveyed in 2004 and again in 2011. Women were dissatisfied with the quality of fertility discussions on both occasions, with fewer women than men remembering such a talk occurring before their cancer treatment began. In 2011 more women remembered a talk before treatment than in 2004, yet they were no more satisfied.

While only based on patient recollections, this study backs up previous anecdotal data. 'This study highlights the need to discuss fertility issues with young patients, especially females, before treatment begins even if there are no options available for fertility preservation', Dr Dan Yeomanson, Consultant Paediatric Oncologist from the Children's NHS Foundation Trust in Sheffield told the BBC.

The authors speculate that higher satisfaction among men might be partly because sperm freezing offers a relatively convenient method to preserve fertility post-treatment, compared to egg embryo or ovary cryopreservation.

These studies underline some of the issues surrounding the reproductive health of young cancer patients; while many women report dissatisfaction with the discussion of possible infertility, it seems that most still manage to achieve pregnancy.

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