![]() For the purposes of this review, the primary outcome of interest is fertility (the ability to conceive a child), and we thus report pregnancy and live birth data whenever possible and use surrogates, such as amenorrhea, semen parameters, and laboratory markers of gonadal insufficiency, as alternatives when necessary ( Figure 1). Randomized trials and prospective observational studies were included preferentially over retrospective studies. Reference lists were reviewed for additional relevant articles. We included only peer-reviewed articles written in English. Search terms included, but were not limited to, names of malignancies (eg, breast cancer, leukemia), cancer therapies (eg, chemotherapies, hormone therapies, biologics, and radiation techniques), and outcomes (eg, pregnancies, birth, fertility, infertility, amenorrhea, azoospermia). We performed a review of published articles describing the risks of cancer treatments to female and male fertility using the PubMed database. This review synthesizes the literature and summarizes the current best estimates of fertility risk from modern day cancer treatment for children and adults to enable clinicians to counsel patients with the most up-to-date understanding of their risks and the potential indication for fertility preservation. However, to our knowledge, there is no recent evaluation regarding the risk of infertility associated with specific diseases and therapies among different age groups. Several recent reviews of fertility preservation strategies have been published ( 4–7) and guidelines crafted ( 8–10). Thus, clinicians should be able to counsel patients with accurate, up-to-date evidence about this critical issue. Proactively addressing this critical survivorship issue for those at risk for infertility is associated with lower regret and improved quality of life ( 3). Fertility should also be considered throughout follow-up, as needed, to address timing and safety of potential pregnancy. Fertility is a survivorship issue that needs to be discussed before initiating therapy to allow for informed decision-making regarding treatment options, family planning, and fertility preservation strategies ( 2). The most comprehensive definition of “cancer survivor” includes patients from diagnosis onwards and recognizes that management of survivorship issues, even those arising years after treatment, must start at diagnosis ( 1). These gains have come with many costs, and, of the long-term treatment sequelae, infertility is among the most important to patients. ![]() ![]() Children and young adults have gained particular benefit, given successes realized in the treatment of childhood acute lymphoblastic leukemia (ALL), Hodgkin lymphoma (HL), and testicular cancer, among other malignancies. Over the past decades, therapeutic advances have transformed the care of cancer patients, yielding substantial improvements in cure rates and survival. ![]()
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