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Author Notes:

Karen Wasilewski-Masker, MD, MSc, Aflac Cancer & Blood Disorders Center, Children’s Healthcare of Atlanta, 5455 Meridian Mark Road, Suite 400, Atlanta, GA 30342, karen.wasilewski@choa.org, Phone: 404-785-3240, Fax: 404-785-3600.

There are no conflicts of interest to declare


Research Funding:

This work was supported by the Lance Armstrong Foundation (L.R.M.); and the National Cancer Institute of the National Institutes of Health, Department of Health and Human Services (U24- CA 55727 to L.L.R.).


  • Science & Technology
  • Social Sciences
  • Life Sciences & Biomedicine
  • Oncology
  • Social Sciences, Biomedical
  • Biomedical Social Sciences
  • Infertility
  • Cancer
  • Male
  • Long-termsurvivors
  • Pediatrics
  • MEN

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

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Journal Title:

Journal of Cancer Survivorship


Volume 8, Number 3


, Pages 437-447

Type of Work:

Article | Post-print: After Peer Review


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.

Copyright information:

© 2014 Springer Science+Business Media New York.

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