title: Pilot initiative in India to explore the gonadal function and fertility outcomes of a cohort of childhood cancer survivors.
abstract: BACKGROUND
  Steady improvement in childhood cancer outcomes has led to a growing number of survivors, many of who develop long-term sequelae. There is limited data about these sequelae (including those related to fertility) on childhood cancer survivors from India.
  
  
  OBJECTIVE
  We undertook a prospective pilot study on childhood cancer survivors from India to assess their gonadal function and fertility.
  
  
  METHODS
  A pediatric oncologist and a reproductive medicine specialist assessed 21 childhood cancer survivors. The risk of infertility was established using disease and treatment variables. Current status of puberty, sexuality, and fertility were assessed using clinical and biochemical parameters. Outcomes were correlated with risk group of infertility. Information was also ascertained on counseling with regards to risk of infertility.
  
  
  RESULTS
  The cohort included 21 survivors (71% males) with a median age of 18 years who were off treatment for a median age of 7 years. Ten (48%) survivors were at low risk for infertility, 9 (43%) at medium risk and 2 (9%) at high risk. Gonadal dysfunction was seen in 3 (14%) survivors: 0/10 (0%) low risk, 1/9 (11%) medium risk, and 2/2 (100%) high risk. None of the survivors, who are at high risk or medium risk of infertility, received any counseling before treatment.
  
  
  CONCLUSIONS
  This prospective pilot study of a cohort of childhood cancer survivors from India demonstrates a deficiency in the information provided and counseling of patients/families at the time of diagnosis with regards to the risk of infertility. Fertility outcomes of childhood cancer survivors were congruent with recognized risk groups for infertility. Future action points have been identified.
authors.affiliation: Nova IVI Fertility Centre, New Delhi, India.
authors.forename: Puneet Rana
authors.initials: PR
authors.lastname: Arora
authors.affiliation: Medanta - The Medicity, Gurgaon, India.
authors.forename: Ruchira
authors.initials: R
authors.lastname: Misra
authors.affiliation: Cankids, India.
authors.forename: Sumit
authors.initials: S
authors.lastname: Mehrotra
authors.affiliation: Cankids, India.
authors.forename: Charu
authors.initials: C
authors.lastname: Mittal
authors.affiliation: Cankids, India.
authors.forename: Sonal
authors.initials: S
authors.lastname: Sharma
authors.affiliation: Cankids, India.
authors.forename: Poonam
authors.initials: P
authors.lastname: Bagai
authors.affiliation: Cankids, India; Max Super-Speciality Hospital, New Delhi, India.
authors.forename: Ramandeep Singh
authors.initials: RS
authors.lastname: Arora
keywords: Childhood cancer; India; fertility; late effects