title: Evidence to incorporate inclusive reproductive health measures in guidelines for childhood and adolescent cancer survivors.
abstract: OBJECTIVE
  Female childhood cancer survivors are at an increased risk of reproductive health impairment. We compared reproductive health outcomes with the recommended standard in a cohort of childhood cancer survivors.
  
  
  METHODS
  A retrospective chart review of 222 female childhood cancer survivors aged 21 years or younger that presented to a tertiary referral center between 1997-2008 was initiated. The main outcome measures were the compliance with the American Society of Clinical Oncology guidelines for childhood cancer survivor management of reproductive health. In particular, we evaluated menstrual cycle regularity, fertility preservation counseling, and endocrine profile, as defined by follicle stimulating hormone (FSH) and anti-mullerian hormone (AMH) levels as surrogate markers for ovarian reserve. Secondary outcomes were to study the contribution of survivor clinics in enforcing these guidelines.
  
  
  RESULTS
  Of 136 patients older than 13 years at their last visit, 58 patients (43%) had FSH data available and none had AMH data. Patients were stratified into 3 groups according to FSH levels. Forty of 58 patients (69%) have normal ovarian reserve (FSH level < 10), 10 of 58 patients (17%) have decreased ovarian reserve (FSH levels 10-40), and 8 of 58 patients (14%) have premature menopause, defined as FSH > 40. Most patients with amenorrhea have elevated FSH levels indicating primary ovarian insufficiency, while 3 patients (2.2%) have low FSH levels consistent with hypothalamic amenorrhea. None of the patients were counseled on fertility preservation.
  
  
  CONCLUSIONS
  Reproductive health follow-up in children with cancer, including FSH and AMH measurement when indicated, should be established and strictly adhered.
authors: Department of Obstetrics and Gynecology, University of Wisconsin, Madison, WI. Electronic address: salih@wisc.edu.
authors: Sana M
authors: SM
authors: Salih
authors: Department of Obstetrics and Gynecology, University of Wisconsin, Madison, WI.
authors: Sarah Z
authors: SZ
authors: Elsarrag
authors: Department of Pediatrics, University of Wisconsin, Madison, WI.
authors: Elizabeth
authors: E
authors: Prange
authors: Department of Obstetrics and Gynecology, University of Wisconsin, Madison, WI.
authors: Karli
authors: K
authors: Contreras
authors: Department of Obstetrics and Gynecology, University of Wisconsin, Madison, WI.
authors: Radya G
authors: RG
authors: Osman
authors: Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, WI.
authors: Jens C
authors: JC
authors: Eikoff
authors: Department of Pediatrics, University of Wisconsin, Madison, WI.
authors: Diane
authors: D
authors: Puccetti
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003376:Counseling; D005260:Female; D059247:Fertility Preservation; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008597:Menstrual Cycle; D009369:Neoplasms / Q000628:therapy*; D060728:Reproductive Health; D034121:Reproductive Health Services / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D017741:Survivors; D055815:Young Adult
keywords: Childhood cancer; Fertility preservation; Ovarian reserve; Reproductive health; Survivor clinics