Obstetrics and Gynecology International Reduced adult uterine volume and blood supply may restrict foetal growth and the ability to carry the foetus to term [22]. There is an increased risk of delivering low birth weight infants (<2.5 kg) amongst patients treated with abdominal/pelvic radiation [22, 23, 25, 71–73]. Patients who receive >5 Gy radiation to the uterus are also sig- niﬁcantly more likely to deliver small for gestational age oﬀspring (<10th percentile for gestational age) [25]. Higher frequencies of preterm birth (<37 weeks) following abdomi- nal/pelvic radiation have additionally been reported [25, 71, 72, 74] with a more recent study observing a 2-fold elevated risk of preterm delivery in their cohort of 351 survivors who received abdominal radiation [22]. There is also an increased risk of miscarriage [22–24], with Reulen et al. reporting the risk to be particularly elevated during the second trimester [22]. In one study of 39 patients who received radiation to the pelvis a signiﬁcantly increased risk of stillbirth at doses >10 Gy was observed [75]. Additionally, doses as low as 1.0– 2.49 Gy were observed to signiﬁcantly increase the risk in girls treated before menarche [75]. Although the exact mech- anism of decreased uterine volume and blood supply on still- birth is unknown, it is possible that these eﬀects may increase the risk of placental or umbilical cord anomalies [75]. 10. Conclusion Although there is individual susceptibility, the late eﬀects of childhood cancer therapies on the reproductive system can be anticipated amongst female childhood cancer sur- vivors throughout their reproductive lives. Girls treated with radiation to the HPO axis are at risk of abnormal timing of menarche and pregnancy sequelae including miscarriage and implantation failure contributing to infertility. 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