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Male infertility in long-term survivors of pediatric cancer: a report from the childhood cancer survivor study

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Abstract

Purpose

The purpose of this study was to assess the prevalence of male infertility and treatment-related risk factors in childhood cancer survivors.

Methods

Within the Childhood Cancer Survivor Study, 1,622 survivors and 274 siblings completed the Male Health Questionnaire. The analysis was restricted to survivors (938/1,622; 57.8 %) and siblings (174/274; 63.5 %) who tried to become pregnant. Relative risks (RR) and 95 % confidence intervals (CI) for the prevalence of self-reported infertility were calculated using generalized linear models for demographic variables and treatment-related factors to account for correlation among survivors and siblings of the same family. All statistical tests were two-sided.

Results

Among those who provided self-report data, the prevalence of infertility was 46.0 % in survivors versus 17.5 % in siblings (RR = 2.64, 95 % CI 1.88–3.70, p < 0.001). Of survivors who met the definition for infertility, 37 % had reported at least one pregnancy with a female partner that resulted in a live birth. In a multivariable analysis, risk factors for infertility included an alkylating agent dose (AAD) score ≥3 (RR = 2.13, 95 % CI 1.69–2.68 for AAD ≥3 versus AAD <3), surgical excision of any organ of the genital tract (RR = 1.63, 95 % CI 1.20–2.21), testicular radiation ≥4 Gy (RR = 1.99, 95 % CI 1.52–2.61), and exposure to bleomycin (RR = 1.55, 95 % CI 1.20–2.01).

Conclusion

Many survivors who experience infertility father their own children, suggesting episodes of both fertility and infertility. This and the novel association of infertility with bleomycin warrant further investigation.

Implications for Cancer Survivors

Though infertility is common, male survivors reporting infertility often father their own children. Bleomycin may pose some fertility risk.

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Funding

This work was supported by the Lance Armstrong Foundation (LRM) and the National Cancer Institute of the National Institutes of Health, Department of Health and Human Services (U24-CA 55727 to LLR).

Conflict of interest

There are no conflicts of interest to declare.

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Authors and Affiliations

  1. Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, 5455 Meridian Mark Road, Suite 400, Atlanta, GA, 30342, USA

    K. Wasilewski-Masker, A. C. Mertens & L. R. Meacham

  2. Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, 30322, USA

    K. Wasilewski-Masker, A. C. Mertens & L. R. Meacham

  3. Clinical Statistics and Cancer Prevention Programs, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA

    K. D. Seidel & W. Leisenring

  4. Division of Pediatric Urology, Seattle Children’s Hospital, University of Washington, Seattle, WA, 98105, USA

    M. Shnorhavorian

  5. Department of Urology, Emory University School of Medicine, Atlanta, GA, 30322, USA

    C. W. Ritenour

  6. Department of Radiation Physics, The University of Texas M.D. Anderson Cancer Center, Houston, TX, 77030, USA

    M. Stovall

  7. Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, 38105, USA

    D. M. Green, G. T. Armstrong & L. L. Robison

  8. Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA

    C. A. Sklar

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  1. K. Wasilewski-Masker
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  6. C. W. Ritenour
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  7. M. Stovall
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  9. C. A. Sklar
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Correspondence to K. Wasilewski-Masker.

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Wasilewski-Masker, K., Seidel, K.D., Leisenring, W. et al. Male infertility in long-term survivors of pediatric cancer: a report from the childhood cancer survivor study. J Cancer Surviv 8, 437–447 (2014). https://doi.org/10.1007/s11764-014-0354-6

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  • DOI: https://doi.org/10.1007/s11764-014-0354-6

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