Leena Nahata1, Vidya Sivaraman2, Gwendolyn P Quinn3. 1. Division of Endocrinology and Center for Biobehavioral Health, The Research Institute, Nationwide Children's Hospital, Columbus, Ohio. Electronic address: leena.nahata@nationwidechildrens.org. 2. Division of Rheumatology, Nationwide Children's Hospital, Columbus, Ohio. 3. Health Outcomes and Behavior Program, Moffitt Cancer Center and Morsani College of Medicine, University of South Florida, Tampa, Florida.
Abstract
OBJECTIVE: To assess fertility counseling and preservation practices among children, adolescents, and young adults with rheumatic diseases undergoing cyclophosphamide (CTX) treatment. DESIGN: Retrospective chart review (2006-2016). SETTING: Academic pediatric center. PATIENT(S): Male and female patients with systemic lupus erythematosus, Wegener's granulomatosis/granulomatosis with polyangiitis, or other vaculitides, receiving CTX treatment. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Documentation of fertility counseling and fertility preservation. RESULT(S): 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. CONCLUSION(S): 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.
OBJECTIVE: To assess fertility counseling and preservation practices among children, adolescents, and young adults with rheumatic diseases undergoing cyclophosphamide (CTX) treatment. DESIGN: Retrospective chart review (2006-2016). SETTING: Academic pediatric center. PATIENT(S): Male and female patients with systemic lupus erythematosus, Wegener's granulomatosis/granulomatosis with polyangiitis, or other vaculitides, receiving CTX treatment. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Documentation of fertility counseling and fertility preservation. RESULT(S): 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. CONCLUSION(S): 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: Molly B Moravek; Leslie C Appiah; Antoinette Anazodo; Karen C Burns; Veronica Gomez-Lobo; Holly R Hoefgen; Olivia Jaworek Frias; Monica M Laronda; Jennifer Levine; Lillian R Meacham; Mary Ellen Pavone; Gwendolyn P Quinn; Erin E Rowell; Andrew C Strine; Teresa K Woodruff; Leena Nahata Journal: J Adolesc Health Date: 2019-01-14 Impact factor: 5.012
Authors: Sharrόn L Manuel; Molly B Moravek; Rafael Confino; Kristin N Smith; Angela K Lawson; Susan C Klock; Mary Ellen Pavone Journal: J Assist Reprod Genet Date: 2019-12-11 Impact factor: 3.412
Authors: Anthony Sabulski; Sara Szabo; Kasiani C Myers; Stella M Davies; Sonata Jodele Journal: Pediatr Blood Cancer Date: 2021-05-21 Impact factor: 3.838