title: Fertility counseling and preservation practices in youth with lupus and vasculitis undergoing gonadotoxic therapy.
abstract: OBJECTIVE
  To assess fertility counseling and preservation practices among children, adolescents, and young adults with rheumatic diseases undergoing cyclophosphamide (CTX) treatment.
  
  
  METHODS
  Retrospective chart review (2006-2016).
  
  
  METHODS
  Academic pediatric center.
  
  
  METHODS
  Male and female patients with systemic lupus erythematosus, Wegener's granulomatosis/granulomatosis with polyangiitis, or other vaculitides, receiving CTX treatment.
  
  
  METHODS
  None.
  
  
  METHODS
  Documentation of fertility counseling and fertility preservation.
  
  
  RESULTS
  A total of 58 subjects met the inclusion criteria; 5 were excluded due to incomplete records, thus N = 53. Of these 75% were female (N = 40). Median age was 14 years at diagnosis and 15 years at first CTX treatment. A total of 51% of subjects (69% of males and 45% of females) had no documentation about potential fertility loss before CTX treatment. Among females where fertility counseling was documented, the only fertility preservation option discussed was leuprolide acetate (LA), which was pursued in all of these cases. Of 13 males (77% postpubertal), 3 were offered sperm banking, of whom 2 declined and the other attempted after treatment began and was azoospermic. Of 53 patients, 1 was referred to a fertility specialist. Mean cumulative CTX dose was 9.2 g in males and 8 g in females.
  
  
  CONCLUSIONS
  Based on these findings, increasing awareness about infertility risk, fertility preservation options, and referral to fertility specialists is needed among pediatric rheumatologists. Prospective studies are needed to assess fertility outcomes in this patient population (including effectiveness of LA with regard to pregnancy rates [PRs]), as well as barriers/facilitators to fertility counseling and fertility preservation.
authors: Division of Endocrinology and Center for Biobehavioral Health, The Research Institute, Nationwide Children's Hospital, Columbus, Ohio. Electronic address: leena.nahata@nationwidechildrens.org.
authors: Leena
authors: L
authors: Nahata
authors: Division of Rheumatology, Nationwide Children's Hospital, Columbus, Ohio.
authors: Vidya
authors: V
authors: Sivaraman
authors: Health Outcomes and Behavior Program, Moffitt Cancer Center and Morsani College of Medicine, University of South Florida, Tampa, Florida.
authors: Gwendolyn P
authors: GP
authors: Quinn
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003376:Counseling; D003520:Cyclophosphamide / Q000009:adverse effects*; D005260:Female; D005298:Fertility / Q000187:drug effects*; D005300:Fertility Agents, Female / Q000627:therapeutic use; D059247:Fertility Preservation / Q000379:methods*; D014890:Granulomatosis with Polyangiitis / Q000175:diagnosis / Q000188:drug therapy*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D007247:Infertility, Female / Q000139:chemically induced* / Q000175:diagnosis / Q000503:physiopathology; D007248:Infertility, Male / Q000139:chemically induced* / Q000175:diagnosis / Q000503:physiopathology; D016729:Leuprolide / Q000627:therapeutic use; D008180:Lupus Erythematosus, Systemic / Q000175:diagnosis / Q000188:drug therapy*; D008297:Male; D010342:Patient Acceptance of Health Care; D010353:Patient Education as Topic; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012662:Semen Preservation; D055815:Young Adult
chemical_list: D005300:Fertility Agents, Female; D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D016729:Leuprolide
keywords: Fertility preservation; cyclophosphamide; fertility counseling; lupus; pediatric rheumatology