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Textbook of Oncofertility Research and Practice pp 3–14Cite as

Fertility Risk with Cancer Therapy

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Abstract

The incidence of cancer has slowly stabilized with 1.7 million new cases estimated in 2018. Of those, 10,270 are estimated to occur in the pediatric population ages 0–14 with 70,000 in the adolescent and young adult (AYA) population ages 15–39. Advances in cancer treatments have significantly improved the outcome for pediatric cancers, with 80% of children now surviving 5 years or more. Unfortunately, 5-year survival rates for AYAs remain lower at 70%. Reasons include differences in tumor biology; fewer available clinical trials, lack of comprehensive insurance coverage, and barriers to access such as location, employment, and educational time constraints. With improvements in treatment, there are estimated to be 500,000 childhood cancer survivors by 2020, and 1 in 25 will be of reproductive age. Compromised fertility occurs in 12% and 66% of at-risk female and male survivors of childhood cancer. Manifestations of gonadal injury include disordered puberty from hormonal deficiency, decreased reproductive and sexual function, psychosocial effects, and menopause-related health problems in female survivors such as genitourinary syndrome of menopause and cardiac, skeletal, and cognitive dysfunction. Standard options for fertility preservation include sperm, oocyte, and embryo banking. Investigational options include testicular and ovarian and immature oocyte cryopreservation. Most options are invasive and costly, and standard options in females require an average of 10–12 days for stimulation and retrieval prior to cancer treatment. Estimating risk prior to therapy allows determination and implementation of the appropriate fertility-preserving therapies. Minimizing risk prior to therapy may mitigate the need for invasive and costly fertility-preserving therapies while preserving hormonal function after cancer treatment.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH, USA

    Leslie Coker Appiah

  2. The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute, Columbus, OH, USA

    Leslie Coker Appiah

  3. Nationwide Children’s Hospital, Columbus, OH, USA

    Leslie Coker Appiah

  4. Department Epidemiology and Cancer Control, Division of Cancer Survivorship, Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA

    Daniel M. Green

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Correspondence to Leslie Coker Appiah .

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Editors and Affiliations

  1. Department of Obstetrics and Gynecology, Northwestern University , Chicago, IL, USA

    Teresa K. Woodruff

  2. Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA, USA

    Divya K. Shah

  3. Department of Obstetrics and Gynecology, University of Rochester, Rochester, NY, USA

    Wendy S. Vitek

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Appiah, L.C., Green, D.M. (2019). Fertility Risk with Cancer Therapy. In: Woodruff, T., Shah, D., Vitek, W. (eds) Textbook of Oncofertility Research and Practice. Springer, Cham. https://doi.org/10.1007/978-3-030-02868-8_1

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