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

• Authors: Karen Wasilewski-Masker, Emory University; K D Seidel, Fred Hutchinson Cancer Research Center; W Leisenring, Fred Hutchinson Cancer Research Center; Ann Mertens, Emory University; M Shnorhavorian, University of Washington; Chad Ritenour, Emory University; M Stovall, University of Texas M.D. Anderson Cancer Center; D M Green, St. Jude’s Children Research Hospital; C A Sklar, Memorial Sloan-Kettering Cancer Center; G T Armstrong, St. Jude’s Children Research Hospital; L L Robison, St. Jude’s Children Research Hospital; Lillian R Meacham, Emory University
• Journal Title: Journal of Cancer Survivorship
• Volume: Volume 8, Number 3
• Publisher: Springer (part of Springer Nature): Springer Open Choice Hybrid Journals | 2014-09-01, Pages 437-447
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1007/s11764-014-0354-6
• Subjects: Health Sciences, Oncology; Health Sciences, Medicine and Surgery
• Keywords: Science & Technology; Social Sciences; Life Sciences & Biomedicine; Oncology; Social Sciences, Biomedical; Biomedical Social Sciences; Infertility; Cancer; Male; Long-termsurvivors; Pediatrics; ACUTE LYMPHOBLASTIC-LEUKEMIA; DOSE RECONSTRUCTION; HODGKINS-DISEASE; GONADAL DAMAGE; HIGH-RISK; FERTILITY; MEN; CHEMOTHERAPY; RADIOTHERAPY; RADIATION

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.