Perceived infertility and contraceptive use in the female, reproductive-age cancer survivor
Perceived infertility, independent of clinical infertility, is related to contraception non-use in female cancer survivors. Contraceptive counseling should address cancer treatment–specific fertility risks and factors important to survivors’ contraception decision making.
Volume 111, Issue 4, Pages 763–771
Tracy N. Hadnott, M.D., Shaylyn S. Stark, M.P.H., Alexa Medica, M.D., Andrew C. Dietz, M.D., Maria Elena Martinez, Ph.D., Brian W. Whitcomb, Ph.D., H. Irene Su, M.D.
To estimate the association between perceived fertility potential and contraception use and to characterize factors important in contraceptive decision making in reproductive-age, female cancer survivors.
Participants were from two state cancer registries, physician referrals, and cancer survivor advocacy groups in the United States.
A total of 483 female survivors aged 18–40 years.
Main Outcome Measure(s)
Eighty-four percent of participants used contraception; 49.7% used highly effective, World Health Organization tiers I and II methods (surgical sterilization, intrauterine devices, contraceptive implant, combined hormonal contraceptives, medroxyprogesterone acetate, progestin-only pills, contraceptive diaphragm). Contraception non-use was more common among survivors who perceived themselves to be infertile, compared with survivors who perceived themselves to be as or more fertile than similarly aged peers (prevalence ratio 4.0, 95% confidence interval 2.5–7.4). In mediation analysis that adjusted for clinical infertility, 59% of the association between prior chemotherapy and contraception non-use was explained by perceived infertility. Contraception efficacy (n = 62, 25.8%) and ease of use (n = 50, 20.8%) were the most cited reasons for using tier I/II methods; compared with lack of hormones (n = 81, 49.7%) as the predominant reason for using less-effective, tier III/IV methods.
Although female, reproductive-age cancer survivors had high uptake of contraception, those who perceived themselves to be infertile were less likely to use contraception. Throughout survivorship, clinicians should counsel survivors on fertility potential in the context of their prior cancer treatments and on factors, including contraceptive efficacy and hormone-free contraception, that inform reproductive decision making in this population.