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Overview of infertility and pregnancy outcome in cancer survivors

Author
Elyce H Cardonick, MD
Section Editors
Charles J Lockwood, MD, MHCM
Robert L Barbieri, MD
Patricia A Ganz, MD
Deputy Editor
Kristen Eckler, MD, FACOG

INTRODUCTION

One of the strongest predictors of emotional well-being in cancer survivors, besides sexual function, appearance, and employability, is feeling healthy enough to be a good parent. Parenthood can represent normalcy, happiness, and life fulfillment. Cancer survivors are often fearful that their history of cancer or its treatment will have an adverse impact on offspring conceived after their cancer treatment, such as placing them at risk for malignancy, congenital anomalies, or impaired growth and development. They are also concerned about the risks of cancer recurrence, infertility, miscarriage, and achieving a successful pregnancy outcome.

Despite these concerns, surveys of female cancer survivors in California and Sweden reported that only about 50 percent recalled receiving reproductive health counseling [1,2]; the proportion is higher in male cancer survivors [2,3]. A subsequent study reported that receiving counseling about reproductive loss and the option to try to preserve fertility before treatment was important to survivors, even if they were unable to have children after chemotherapy [3]. Others have noted that the rate of elective pregnancy termination among female cancer survivors was higher compared to sibling controls because of the fear that their prior cancer therapy would affect their children [4]. Patient education regarding future reproductive function is thus an important component of the care of individuals with cancer [3].

FERTILITY ISSUES

Risk of infertility among cancer survivors — Infertility in cancer survivors can be caused by injury to the hypothalamic-pituitary-gonadal axis, as well as damage to the organs of the reproductive tract. Cytotoxic drugs, radiation therapy, surgery, and the disease process itself can all cause infertility, which may be temporary or permanent. The magnitude of risk depends on multiple factors, including:

Type and stage of cancer

Drug class and cumulative dose

               

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Literature review current through: Jul 2017. | This topic last updated: May 30, 2017.
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