Fertility in Our Allogeneic Hematopoietic Stem Cell Transplant Patients
Authors: Topcuoglu Pervin , Ataca Pinar , Bozdag Sinem Civriz , Toprak Selami Kocak , Arslan Onder , Ozcan Muhit , Demirer Taner , Konuk Nahide , Akan Hamdi , Ilhan Osman , Beksac Meral , Gurman Gunhan 
Published: October 2019

Abstract
Introduction
Survival after hematopoietic stem cell transplantation has increased due to effective supportive treatment. Infertility is a major late side effect after transplantation. Fertility preservation is an essential step in the young patient’s therapy. In this paper, we aim to present our experience with fertility after allogeneic stem cell transplantation.
Method
We retrospectively evaluated the fertility of 122 (14%) of 849 patients who had allogeneic stem cell transplantation (ASCT) between 1989-2012 at the Ankara University Hematology Department and survived 2 years or more after the procedure. We used Pearson chi-square test to compare groups. P< .05 was considered statistically significant.
Results
Of the 122 patients, 56 (46%) were female and 66 were male (54%). The mean age of ASCT in the female patients was 33.48 ± 8.41, whereas the mean age in the male patients was 32.85 ± 7.92. The mean follow-up period was 90.74 ± 53.51 months (range 18-237 months). Six of the female patients (11%) and 16 of the male patients (24%), a total of 22 patients (18%) had a child after ASCT. The female patients became pregnant naturally, whereas the partners of the 2 male patients became pregnant via in vitro fertilization (IVF). The mean time period from ASCT and pregnancy to fertility evaluation was 68.5 ± 27.5 months in male patients and 63.3 ± 35.5 months in female patients. In most patients who had a child after ASCT, the initial diagnosis was bone marrow failure and chronic myeloproliferative disease. As expected, chemotherapy was used less in these groups (P=.005). All patients who had given birth after ASCT had received transplants from full-match HLA sibling donors or relatives. We could not demonstrate a relationship between fertility and unrelated donor transplantation because the frequency of cases was low (Table 1). The conditioning regimen, total body irridation (TBI) and its frequency, and acute or chronic graft vs. host disease (GVHD) had no impact in fertility (P >.05). However, a relapse of the disease had an unfavorable effect on fertility (P=.04).
Conclusions
Treatments prior to ASCT have damaging effects on gonadal tissue and induce infertility. The nature of the initial diagnosis, a prior chemotherapy regimen before ASCT, and a relapse of the primary disease contribute to infertility. Unexpectedly, we found no relation between the myeloablative conditioning regimen, radiotherapy prior to ASCT, TBI usage and frequency, development of acute and chronic GVHD and infertility.
Table 1: Distribution and comparison of fertile and unfertile patients Parameters Fertility Yes % (n=22) Fertility No (n=100) P Diagnosis Acute leukemia (AML, ALL, sec leukemia) Chronic MPD (CML, PMF) Bone marrow Failure (AAA, PNH, MDS) Others (Lymphoma, Myeloma) 10.8% (7/22) 45.5% (10/22) 22.7% (5/22) 0% (0/22) 58% (58/100) 28% (28/100) 5% (5/100) 9% (9/100) 0.005* Relative donors 100% (22/22) 96% (96/100) 1.0 Chemotherapy prior to ASCT 72.7% (16/22) 93% (93/100) 0.005* Radiotherapy prior to ASCT 0% (0/22) 3% (3/100) 0.55 Myeloablative conditioning regimen 95.5% (21/22) 90% (90/100) 0.69 TBI in conditioning regimen 0.5% (1/22) 12% (12/100) 0.46 Acute GVHD 36.4% (8/22) 38% (38/100) 0.89 Chronic GVHD 54.5% (12/22) 64% (64/100) 0.41 Disease relapse 0.09% (2/22) 31% (31/100) 0.04*

Disclosures
No relevant conflicts of interest to declare.