Many young women and children with cancer are faced with the reality of fertility complications following treatment. In fact, nearly 11% of female childhood cancer survivors will be at risk for reproductive and bone-related complications due to post-treatment ovarian complications. The development of premature ovarian failure can lead to hormonal complications, including lower than normal levels of estrogen production, and infertility.
New research recently published in the Journal of Clinical Endocrinology
and Metabolism analyzed 921 female childhood cancer survivors revealing
fertility side effects in this population. Investigators from St. Jude’s Children’s
Hospital found that while the dose of abdominal radiation is not a factor, simply
having radiation to the abdomen is a risk factor for the development of ovarian
insufficiency. Additionally, they report that those who have also received treatment
with high-dose alkylating chemotherapy had an even higher risk of developing
premature ovarian failure.
Data from the study also revealed that the analyzed childhood cancer survivors experienced poorer overall health. They noted a 5-fold increase in low bone mineral density (a risk factor for osteoporosis/fractures) and over a 3-fold increase in frailty.
In the general population of women with ovarian insufficiency, current recommendations for hormone replacement therapy to decrease the risk of cardiovascular disease and low bone mineral density include treatment until age 45. This study reveals that of the 100 patients who experienced premature ovarian failure, only 31 were noted to be receiving hormone replacement therapy.
"The past decade has seen tremendous progress in female fertility preservation, which makes these results timely," explained lead author Wassim Chemaitilly, MD, associate member of St. Jude’s Department of Pediatric Medicine, Division of Endocrinology. "Survivors, both men and women, tell us that the ability to have children is important to them. Better defining the risk factors and prevalence of premature ovarian insufficiency in female survivors will help better identify patients who are most likely to benefit from fertility preservation."
He also noted that the study reveals possible obstacles survivors face to receiving hormone replacement therapy, which merit further study. Chemaitilly added, "Some survivors may not have access to appropriate care. For other survivors and their physicians, the issue may be balancing the benefits of hormone placement therapy with the potential risks, including the risk of second cancers in some survivors."
This study also revealed a correlation with body mass and premature ovarian failure risk, reporting that obese survivors were 40% less likely to be diagnosed with premature ovarian failure as opposed to their thinner counterparts.
"Obesity during cancer treatment is known as a strong predictor for obesity later in life. For now, we can only speculate that being overweight or underweight during treatment may, for whatever reason, influence or predict ovarian vulnerability to either radiation or chemotherapy,” Dr. Chemaitilly notes.
The question now is who will benefit from pre-treatment fertility preservation. Dr. Chemaitilly believes that precision medicine and genetics may offer promising answers.
Chemaitilly W, Li Z, Krasin MJ, et al. Premature Ovarian Insufficiency in Childhood Cancer Survivors: A Report from the St. Jude Lifetime Cohort. J Clin Endocrinol Metab. 2017 Mar 24. doi: 10.1210/jc.2016-3723. [Epub ahead of print]