Pre-treatment fertility preservation and post-treatment reproduction in long-term survivors of adolescent and young adult (AYA) cancer

Vicky Lehmann; Carla Vlooswijk; Winette T A van der Graaf; Rhodé Bijlsma; Suzanne E J Kaal; Jan Martijn Kerst; Jacqueline M Tromp; Monique E M M Bos; Tom van der Hulle; Roy I Lalisang; Janine Nuver; Mathilde C M Kouwenhoven; Christianne A R Lok; Catharina C M Beerendonk; Marij Dinkelman-Smit; Olga Husson

doi:10.1007/s11764-024-01538-x

Pre-treatment fertility preservation and post-treatment reproduction in long-term survivors of adolescent and young adult (AYA) cancer

J Cancer Surviv. 2024 Feb 6. doi: 10.1007/s11764-024-01538-x. Online ahead of print.

Authors

Vicky Lehmann^{1

2}, Carla Vlooswijk³, Winette T A van der Graaf^{4

5}, Rhodé Bijlsma⁶, Suzanne E J Kaal⁷, Jan Martijn Kerst⁸, Jacqueline M Tromp⁹, Monique E M M Bos⁵, Tom van der Hulle¹⁰, Roy I Lalisang¹¹, Janine Nuver¹², Mathilde C M Kouwenhoven^{13

14}, Christianne A R Lok¹⁵, Catharina C M Beerendonk¹⁶, Marij Dinkelman-Smit¹⁷, Olga Husson^{4

5}

Affiliations

¹ Department of Medical Psychology, Amsterdam University Medical Center/University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. v.lehmann@amsterdamumc.nl.
² Cancer Center Amsterdam (CCA), Amsterdam, The Netherlands. v.lehmann@amsterdamumc.nl.
³ Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.
⁴ Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
⁵ Department of Medical Oncology, ErasmusMC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands.
⁶ Department of Medical Oncology, UMC Utrecht Cancer Center, Utrecht, The Netherlands.
⁷ Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands.
⁸ Department of Medical Oncology, Netherlands Cancer Institute-Antoni Van Leeuwenhoek, Amsterdam, The Netherlands.
⁹ Department of Medical Oncology, Amsterdam University Medical Center/University of Amsterdam, Amsterdam, The Netherlands.
¹⁰ Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands.
¹¹ Department of Internal Medicine, GROW-School of Oncology and Reproduction, Maastricht UMC, Maastricht, The Netherlands.
¹² Department of Medical Oncology, University Medical Center Groningen, Groningen, The Netherlands.
¹³ Cancer Center Amsterdam (CCA), Amsterdam, The Netherlands.
¹⁴ Department of Neurology, Amsterdam University Medical Centers/University of Amsterdam, Amsterdam, The Netherlands.
¹⁵ Department of Gynecologic Oncology, Center Gynaecologic Oncology Amsterdam, Antoni Van Leeuwenhoek, Amsterdam, The Netherlands.
¹⁶ Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands.
¹⁷ Department of Urology, ErasmusMC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands.

PMID: 38316726
DOI: 10.1007/s11764-024-01538-x

Abstract

Purpose: To describe recall of fertility-related consultations and cryopreservation and to examine reproductive goals and reproduction post-treatment in long-term survivors of adolescent and young adult (AYA) (age, 18-39 years) cancer.

Methods: This study included n = 1457 male and n = 2112 female long-term survivors (M_age = 43-45 years; 5-22 years from diagnosis) who provided self-report. Clinical data were supplied by the Netherlands Cancer Registry.

Results: Most male survivors (72.7%) recalled fertility-related consultations and 22.6% completed sperm cryopreservation. Younger age (OR = 2.8; 95%CI [2.2-3.6]), not having children (OR = 5.0; 95%CI [3.2-7.7]), testicular cancer or lymphoma/leukemia (OR = 2.8/2.5 relative to "others"), and more intense treatments (OR = 1.5; 95%CI [1.1-2.0]) were associated with higher cryopreservation rates. Time since diagnosis had no effect. Of men who cryopreserved, 12.1% utilized assisted reproductive technologies (ART). Most men (88.5%) felt their diagnosis did not affect their reproductive goals, but 7.6% wanted no (additional) children due to cancer. Half of female survivors (55.4%; n = 1171) recalled fertility-related consultations. Rates of cryopreservation were very low (3.6%), but increased after 2013 when oocyte cryopreservation became non-experimental. Of women who cryopreserved, 13.2% successfully utilized ART. Most women (74.8%) experienced no effects of cancer on reproductive goals, but 17.8% wanted no (additional) children due to cancer.

Conclusions: Cryopreservation in men varied by patient/clinical factors and was very low in women, but data of more recently treated females are needed. Utilizing cryopreserved material through ART was rare, which questions its cost-effectiveness, but it may enhance survivors' well-being.

Implications for cancer survivors: The extent to which cryopreservation positively affects survivors' well-being remains to be tested. Moreover, effects of cancer on reproductive goals require further attention, especially in women who refrain from having children due to cancer.

Keywords: Adolescence and young adulthood (AYA); Assisted reproductive technologies (ART); Fertility preservation; Oncology; Reproductive goals.

Abstract

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