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. 2014 Sep;8(3):437-47.
doi: 10.1007/s11764-014-0354-6. Epub 2014 Apr 8.

Male infertility in long-term survivors of pediatric cancer: a report from the childhood cancer survivor study

K Wasilewski-Masker  1 , K D Seidel, W Leisenring, A C Mertens, M Shnorhavorian, C W Ritenour, M Stovall, D M Green, C A Sklar, G T Armstrong, L L Robison, L R Meacham
Affiliations

Male infertility in long-term survivors of pediatric cancer: a report from the childhood cancer survivor study

K Wasilewski-Masker et al. J Cancer Surviv. 2014 Sep.

Abstract

Purpose: The purpose of this study was to assess the prevalence of male infertility and treatment-related risk factors in childhood cancer survivors.

Methods: Within the Childhood Cancer Survivor Study, 1,622 survivors and 274 siblings completed the Male Health Questionnaire. The analysis was restricted to survivors (938/1,622; 57.8 %) and siblings (174/274; 63.5 %) who tried to become pregnant. Relative risks (RR) and 95 % confidence intervals (CI) for the prevalence of self-reported infertility were calculated using generalized linear models for demographic variables and treatment-related factors to account for correlation among survivors and siblings of the same family. All statistical tests were two-sided.

Results: Among those who provided self-report data, the prevalence of infertility was 46.0 % in survivors versus 17.5 % in siblings (RR = 2.64, 95 % CI 1.88-3.70, p < 0.001). Of survivors who met the definition for infertility, 37 % had reported at least one pregnancy with a female partner that resulted in a live birth. In a multivariable analysis, risk factors for infertility included an alkylating agent dose (AAD) score ≥3 (RR = 2.13, 95 % CI 1.69-2.68 for AAD ≥3 versus AAD <3), surgical excision of any organ of the genital tract (RR = 1.63, 95 % CI 1.20-2.21), testicular radiation ≥4 Gy (RR = 1.99, 95 % CI 1.52-2.61), and exposure to bleomycin (RR = 1.55, 95 % CI 1.20-2.01).

Conclusion: Many survivors who experience infertility father their own children, suggesting episodes of both fertility and infertility. This and the novel association of infertility with bleomycin warrant further investigation.

Implications for cancer survivors: Though infertility is common, male survivors reporting infertility often father their own children. Bleomycin may pose some fertility risk.

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Conflict of interest statement

Conflict of Interest: There are no conflicts of interest to declare

Figures

Figure 1
Figure 1. Participants in the Childhood Cancer Survivor Study Male Health Questionnaire and infertility analysis
*Assessment of associations between infertility and cancer treatments received for primary cancer diagnosis was limited to subjects with no recurrence of the primary cancer and no secondary malignancy neoplasm.
See this image and copyright information in PMC

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