Female Fertility After Allogeneic Stem Cell Transplantation in Denmark. A National Cohort Study

Background:

It is well known that female fertility is impaired after allogeneic stem cell transplantation (SCT), however, more female patients become long term survives, and wish to have children of their own. Data regarding pregnancies and child births are scarce. The aim of this study was to determine the proportion of female patients obtaining documented pregnancy and motherhood following SCT.

Methods:

We obtained data regarding pregnancies and child births in consecutive female transplant recipients from our center. The patients were treated with SCT in the period from 1976 to 2012. Data was obtained through the national centralized access to the patients´ medical records including specialist treatment. Patients less than 17 years of age at the time of analysis were excluded. In total, 161 women were included in the analysis. The median age at SCT was 17.2 years, and 31.4 years at analysis. Of the 161 women, 24 (15%) died in the observation period, the surviving 138 women were observed median 12.3 years (0.5-36).

Results:

Of the 161 women, 20 (12.3%) had at least one documented pregnancy (i.e. fertile). One of the 20 women which experienced pregnancy is dead and never gave birth. Thirteen (8%) woman obtained motherhood: 8 had one child, 5 had two children. All children born were healthy. Among the women with a pregnancy, 9/20 (45%) had non-malignant hematological disease, and 11/20 (55%) had malignant disease, among the non-fertile women the numbers were 36/141 (25%) and 106/141 (75%), respectively (p=0.66). Of the woman with motherhood, 7/13 (54%) had non-malignant disease, whereas 38/148 (26%) of the remaining women had non-malignant disease (p=0,029)  

Total body irradiation (TBI) was given to 7 (54%) of the women with completed delivery, at a dosage of 200 cGy in 2 and 850-1200 cGy in 5 patients.

The median age at HSCT was not different among fertile and non-fertile women, 18.6 (2.3-33) years and 16.7 (0,2-34,6) years respectively (p=0.91).

Among evaluable patients, chronic graft versus host disease (GvHD) was documented in 4/18 (22%) of the fertile women, and 43/116 (37%) of the non-fertile women, p=0,22.

Conclusion:

Not all women are infertile following allogeneic SCT, despite treatment with TBI chemotherapy and chronic GvHD. However, only 8% obtained motherhood, emphasizing the need for fertility conservation procedures. The current study benefits from centralized access to patient information ensuring a high quality of accurate and complete data.