Reproductive intentions in childless female adolescent and young adult cancer survivors

One-fifth of female adolescent and young adult cancer survivors are voluntarily childless. Voluntary childlessness was not related to cancer characteristics, supporting assessing reproductive intentions across survivors and individualizing reproductive care.

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Volume 113, Issue 2, Pages 392–399

Authors:

Christina M. Lam, M.D., Ksenya Shliakhtsitsava, M.D., M.A.S., Shaylyn S. Stark, M.P.H., Alexa C.O. Medica, M.D., Kelsey A. Pinson, M.D., Brian W. Whitcomb, Ph.D., H. Irene Su, M.D., M.S.C.E.

Abstract:

Objective

To examine the association between prior cancer treatments, medical comorbidities, and voluntary childlessness in reproductive-age women who are survivors of cancers diagnosed as adolescents and young adults (AYA survivors).

Design

Cross-sectional analysis.

Setting

Participants were recruited from California and Texas cancer registries, fertility preservation programs, and cancer advocacy groups.

Patient(s)

Women (n = 413) ages 18–40 who were diagnosed with cancer between ages 15 and 35, completed primary cancer treatments, had at least one ovary, and were nulliparous.

Intervention(s)

Cancer treatment gonadotoxicity and medical comorbidities.

Main Outcome Measure(s)

Voluntary childlessness.

Result(s)

The mean age of survivors was 31.8 years (SD, 4.9) with a mean of 6.5 years (SD, 4.4) since cancer diagnosis. Breast (26%), thyroid (19%), and Hodgkin lymphoma (18%) were the most common cancers. Twenty-two percent of the cohort was voluntarily childless. Medical comorbidities, cancer diagnosis, prior surgery, prior chemotherapy, and prior gonadotoxic treatments were not significantly associated with voluntary childlessness. In adjusted analysis, survivors of older reproductive age (adjusted odds ratio = 2.97 [1.71–5.18]) and nonheterosexual participants (adjusted odds ratio = 4.71 [2.15–10.32]) were more likely to report voluntary childlessness.

Conclusion(s)

A moderate proportion of AYA cancer survivors are voluntarily childless, but reproductive intentions were not related to cancer type or cancer treatments. AYA survivors of older age and nonheterosexual identification were more likely to be voluntarily childless. These data support assessing reproductive intentions and tailoring reproductive care such as fertility and contraception counseling that is appropriate for a survivor’s intentions.


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Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.

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