2. Deparment of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA.
3. Department of Obstetrics and Gynecology, Cornell University, New York, NY, USA.
4. Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA.
5. Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
Background: Little is known about how to predict post-treatment reproductive health outcomes in reproductive-age women with cancer. We sought to determine whether predictors like age, parity, temporary post-treatment amenorrhea, or posttreatment infertility are associated with reproductive compromise.
Methods: We contacted 2532 women from a statewide cancer registry (randomly sampled; diagnosed from 1993-2007; ages 18-40 at diagnosis) with a history of chemotherapy treatment for leukemia, lymphoma, breast and gastrointestinal GI) cancers. Using a written and electronic survey, we evaluated outcomes including temporary amenorrhea, permanent amenorrhea, infertility, and early menopause (age < 45). Logistic regression was used to determine the probability of amenorrhea and infertility, based on clinical predictors. Censored data methods were used to determine the probability of early menopause.
Results: Out of 1041 responders, 620 women who received chemotherapy alone were included in the analysis of reproductive compromise. One-third noted menses had ceased during or immediately after treatment and one-half of these women noted a subsequent return of menstruation. Temporary amenorrhea post-treatment - but not duration of amenorrhea - predicted a trend toward increased rates of infertility (adjusted odds ratio (AOR) 2.2, 95% CI 1.0-4.8). Post-treatment infertility was significantly associated with an increased risk for earlier menopause (p<0.05 compared to those who did conceive).
Conclusions: In this population, clinical metrics including a history of post-treatment amenorrhea and/or infertility appeared to predict risk of future reproductive impairment. These parameters could be used to develop guidelines for triage to reproductive health specialists in women with curable malignancies for whom chemotherapy is recommended.
Keywords: Chemotherapy, fertility, menopause, amenorrhea, quality of life, breast cancer, leukemia, hodgkin's disease, non hodgkin lymphoma, gastrointestinal cancer