Overview of infertility and pregnancy outcome in cancer survivors
- Elyce H Cardonick, MD
Elyce H Cardonick, MD
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Cooper Health System, Camden, New Jersey
- Section Editors
- Charles J Lockwood, MD, MHCM
Charles J Lockwood, MD, MHCM
- Section Editor — Obstetrics
- Senior Vice President, USF Health
- Dean, Morsani College of Medicine
- Professor, Obstetrics and Gynecology
- University of South Florida
- Robert L Barbieri, MD
Robert L Barbieri, MD
- Editor-in-Chief — Obstetrics, Gynecology and Women's Health
- Section Editor — General Gynecology and Female Reproductive Endocrinology
- Kate Macy Ladd Professor of Obstetrics, Gynecology and Reproductive Biology
- Harvard Medical School
- Patricia A Ganz, MD
Patricia A Ganz, MD
- Section Editor — Cancer Survivorship
- UCLA Schools of Medicine and Public Health
- Jonsson Comprehensive Cancer Center
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 . 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 . Patient education regarding future reproductive function is thus an important component of the care of individuals with cancer .
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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- FERTILITY ISSUES
- Risk of infertility among cancer survivors
- Pretreatment approaches to preservation of fertility
- Assessment of fertility potential after cancer therapy
- Risk of cancer recurrence
- Treatment of infertility
- PREGNANCY ISSUES
- Risk of congenital and chromosomal abnormalities
- Risk of miscarriage, preterm birth, growth restriction, stillbirth
- Pregnancy after breast cancer
- Pregnancy management
- CANCER ISSUES
- Cancer risk in offspring
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS