title: Pregnancy after cancer: results from a prospective cohort study of cancer survivors.
abstract: BACKGROUND
  Future fertility is an important concern for many cancer survivors. Cancer therapies have been shown to adversely impact reproductive function. However, it is difficult to predict the extent to which reproductive dysfunction will occur. The purpose of this study was to compare measures of ovarian reserve (MOR) and pregnancy rates in young female cancer survivors and similar-aged controls.
  
  
  METHODS
  A prospective cohort study was conducted in a university-hospital setting. Participants were followed annually for a mean 25 months to assess reproductive history, the incidence of pregnancy, and MOR (serum follicle-stimulating hormone, luteinizing hormone, estradiol, inhibin B, anti-mullerian hormone (AMH), antral follicle counts and mean ovarian volume).
  
  
  RESULTS
  Eighty-four female survivors (average age 26, and 14 years post-treatment) and 98 similar-aged controls that were sexually active with men were included. At baseline, 27/84 survivors and 42/98 controls reported a prior pregnancy. Adjusted models showed that anti-mullerian hormone (AMH) and antral follicle count (AFC) were impaired in survivors with a prior pregnancy compared to controls with a prior pregnancy (P < 0.01, P = 0.03). During follow-up in 56 survivors and 74 controls, 19 pregnancies occurred in survivors and 18 in controls. Comparison of MOR between survivors who became pregnant and controls who became pregnant revealed that AMH and AFC were impaired in survivors (P < 0.05). Compared to survivors who did not become pregnant, survivors who did were older (P < 0.01) and more likely to be cohabitating (P < 0.01), but had similar MOR and exposure to alkylators (P = 0.34).
  
  
  CONCLUSIONS
  Survivors achieved pregnancy at a rate similar to controls despite impaired MOR.
authors.affiliation: Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Katherine E
authors.initials: KE
authors.lastname: Dillon
authors.forename: Mary D
authors.initials: MD
authors.lastname: Sammel
authors.forename: Jill P
authors.initials: JP
authors.lastname: Ginsberg
authors.forename: Lara
authors.initials: L
authors.lastname: Lechtenberg
authors.forename: Maureen
authors.initials: M
authors.lastname: Prewitt
authors.forename: Clarisa R
authors.initials: CR
authors.lastname: Gracia
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects*; D015331:Cohort Studies; D005260:Female; D005298:Fertility; D006801:Humans; D009369:Neoplasms / Q000150:complications* / Q000628:therapy; D010053:Ovary / Q000187:drug effects* / Q000528:radiation effects*; D011247:Pregnancy; D018873:Pregnancy Rate; D011878:Radiotherapy / Q000009:adverse effects; D017741:Survivors / Q000706:statistics & numerical data
chemical_list: D000970:Antineoplastic Agents
keywords: cancer survivors; chemotherapy; fertility; ovarian reserve
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