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Study shows how chemotherapy may affect women’s fertility

August 26, 2011

By Patricia Nicholson

A new study of cancer survivors suggests that chemotherapy may affect women’s fertility, even if their periods return after treatment.

Many women undergoing chemotherapy experience amenorrhea, meaning that their periods stop during treatment. In most cases, their periods return within one year, especially in younger women. However, some women experience permanent ovarian failure.

A study of more than 600 cancer survivors found that even among those whose periods returned, women who had undergone chemotherapy were at increased risk for infertility and early menopause.

Researchers at the University of California at San Francisco School of Medicine surveyed 620 women who were diagnosed with cancer between the ages of 18 and 40. All of the women had been treated with chemotherapy alone (not with pelvic radiation, pelvic surgery or bone marrow transplants that may affect fertility).

The women were treated for either Hodgkin’s disease, non-Hodgkin’s lymphoma, breast cancer, leukemia or gastrointestinal cancers. Average age at diagnosis was 31, and average time since their diagnosis was 9.4 years.

Half of the women had children before they were treated for cancer, and more than half (57 per cent) said they wanted to have children after their cancer treatment. However, only 36 per cent tried to get pregnant after treatment, and only 19 per cent gave birth after treatment.

Fertility problems varied by age and by type of cancer. The number of women whose periods stopped and had not returned one year after treatment was lowest among women with leukemia (three per cent), and highest in breast cancer patients (nine per cent) and those with non-Hodgkin’s lymphoma (10 per cent). This was significantly more common among older women.

Among those whose periods returned after treatment, rates of 12-month infertility (no pregnancy after one year of trying to conceive) were high. According to background information in the study, the 12-month infertility rate among U.S. women is about seven per cent. However, the rates for the women in the study ranged from more than double that level to almost quadruple: 15 per cent of women treated for non-Hodgkin’s lymphoma, 18 per cent of those who had Hodgkin’s disease, 20 per cent of women treated for leukemia, 23 per cent of those who had gastrointestinal cancers, and 27 per cent of women who underwent chemotherapy for breast cancer reported 12-month infertility, even though their periods returned after treatment.

In women who were treated for breast cancer and Hodgkin’s disease, 12-month infertility was significantly more common in older women.

In women whose periods returned after treatment, early menopause (before age 45) was significantly linked to chemotherapy for three types of cancer: Hodgkin’s disease, non-Hodgkin’s lymphoma and gastrointestinal cancers. Early menopause was also related to age. The younger a woman was at the time of her diagnosis, the higher her risk of early menopause. For example, a woman diagnosed with Hodgkin’s disease at age 20 had a 37 per cent risk of early menopause, while a woman diagnosed at age 35 had a 16 per cent risk.

These findings could be very useful in counselling women diagnosed with cancer during their reproductive years about their fertility, and fertility preservation options such as egg harvesting.

The study was published online in the journal Cancer on Aug. 17, 2011.

 

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