Fertility in Our Allogeneic Hematopoietic Stem Cell Transplant Patients

Introduction

Survival after hematopoietic stem cell transplantation has increased due to effective supportive treatment. Infertility is a major late side effect after transplantation. Fertility preservation is an essential step in the young patient’s therapy. In this paper, we aim to present our experience with fertility after allogeneic stem cell transplantation.

Method

We retrospectively evaluated the fertility of 122 (14%) of 849 patients who had allogeneic stem cell transplantation (ASCT) between 1989-2012 at the Ankara University Hematology Department and survived 2 years or more after the procedure. We used Pearson chi-square test to compare groups. P< .05 was considered statistically significant.

Results

Of the 122 patients, 56 (46%) were female and 66 were male (54%). The mean age of ASCT in the female patients was 33.48 ± 8.41, whereas the mean age in the male patients was 32.85 ± 7.92. The mean follow-up period was 90.74 ± 53.51 months (range 18-237 months). Six of the female patients (11%) and 16 of the male patients (24%), a total of 22 patients (18%) had a child after ASCT. The female patients became pregnant naturally, whereas the partners of the 2 male patients became pregnant via in vitro fertilization (IVF). The mean time period from ASCT and pregnancy to fertility evaluation was 68.5 ± 27.5 months in male patients and 63.3 ± 35.5 months in female patients. In most patients who had a child after ASCT, the initial diagnosis was bone marrow failure and chronic myeloproliferative disease. As expected, chemotherapy was used less in these groups (P=.005). All patients who had given birth after ASCT had received transplants from full-match HLA sibling donors or relatives. We could not demonstrate a relationship between fertility and unrelated donor transplantation because the frequency of cases was low (Table 1). The conditioning regimen, total body irridation (TBI) and its frequency, and acute or chronic graft vs. host disease (GVHD) had no impact in fertility (P >.05). However, a relapse of the disease had an unfavorable effect on fertility (P=.04).

Conclusions

Treatments prior to ASCT have damaging effects on gonadal tissue and induce infertility. The nature of the initial diagnosis, a prior chemotherapy regimen before ASCT, and a relapse of the primary disease contribute to infertility. Unexpectedly, we found no relation between the myeloablative conditioning regimen, radiotherapy prior to ASCT, TBI usage and frequency, development of acute and chronic GVHD and infertility.