Perspectives Regarding Fertility in Female Adolescent and Young Adult Childhood Cancer Survivors
Authors: Rao Pooja , Hirway Priya , Welch Jennifer JG , Schwartz Cindy L 
Published: October 2019

Abstract
Introduction:
Reproductive system injury, particularly ovarian failure, can be a devastating consequence of cancer treatment for female childhood cancer survivors. Recent advances in reproductive technology offer new fertility preservation techniques such as oocyte and ovarian tissue cryopreservation in addition to ovarian transposition and embryo cryopreservation. With rapid expansion of these reproductive technologies, it is imperative that we understand the personal perspectives regarding fertility of young female cancer patients. Better understanding of their attitudes will enable care providers to better counsel patients and families about options. We designed our study to evaluate the perspectives of female adolescent and young adult childhood cancer survivors regarding (a) fertility preservation procedures at the time of cancer diagnosis and (b) their prioritization of life goals, including fertility and motherhood.
Methods:
This study was a cross-sectional survey of female adolescent and young adult cancer survivors between 15-25 years of age at Hasbro Children's Hospital. Surveys were mailed to participants and followed with a reminder postcard and $5 incentive for participation. Written informed consent and assent were obtained.
The primary study outcomes were responses to: (1) potential interest in fertility-sparing surgery at cancer diagnosis and (2) whether they would have waited to start cancer treatment if it increased future chances of becoming pregnant. Covariates included demographics (age at diagnosis, current age, race, ethnicity, education level) as well as prioritization of life goals, including fertility and motherhood, on a Likert scale from 0-5. Stata 12.0 (College Station, TX) was used to conduct chi-squared or t-tests for bivariate analysis. Logistic regression was used to calculate crude and adjusted odds ratios.
Results:
Sixty-five completed surveys were returned, with a 42% response rate. The mean age of subjects was 20.1 years (SD, 2.8). The majority (83.1%) were White, and non-Hispanic (92%). The most common participant cancer diagnoses were acute lymphoblastic leukemia, brain tumors, sarcomas and neuroblastoma. After adjusting for confounders including age at diagnosis and race, the odds of wanting surgery was higher (OR 2.41, 95% CI 1.42-4.09) for those who ranked pregnancy highly (> 4) and for those who ranked being a mother highly (OR 2.62, 95% CI 1.46-4.69) vs. those who did not. The adjusted odds of being willing to postpone cancer treatment for those who ranked pregnancy and motherhood highly (> 4) also remained statistically significant (OR 2.81, 95% CI 1.15-6.90; OR 3.73, 95% CI 1.14-12.6), respectively.
Conclusion:
Fertility and motherhood are important to female adolescent and young adult childhood cancer survivors. This study shows these young women would be interested in pursuing fertility preservation procedures at the time of cancer diagnosis, even if it meant a delay in starting cancer treatment. Pediatric oncologists should use this information to advise patients and families regarding fertility preservation options. A caveat remains however that patients would need to be counseled regarding the risks of such decisions in consideration of their specific illness.

Disclosures
No relevant conflicts of interest to declare.