Purpose An increasing number of childhood cancer survivors are using assisted reproductive technologies (ART) to overcome treatment-related fertility impairment. We report perinatal and health outcomes of offspring born to survivors following ART. Methods The FeCt Multicenter Offspring Study surveyed the health of offspring of childhood cancer survivors. Health outcomes in offspring born to survivors following ART (n = 57, 4.6%) or after spontaneous conception (n = 1182) were assessed in the German cohort (n = 1239) using bivariate analysis. Findings were put into the context of the general German population by health outcome assessment in 1:1 matched-pair analysis (n = 2478). Results Nearly twice the survivors used ART compared with numbers reported for the German general population (4.6% vs. 2.6%). Successful pregnancies were achieved after a median of two cycles, mainly using non-cryopreserved oocytes/sperm. Multiple sibling births (p < 0.001, 28.1% vs. 3.0%) and low birth weight (p = 0.008; OR = 2.659, 95% CI = 1.258-5.621) occurred significantly more often in offspring born to survivors who utilized ART than spontaneously conceived children, whereas similar percentages were born preterm or too small for their gestational age. ART did not increase the prevalence of childhood cancer or congenital malformations in offspring born to survivors. Conclusion ART use by childhood cancer survivors was successful with both fresh and cryopreserved oocytes/sperm, and did not influence perinatal health or health outcomes when known confounders were taken into account. Implications for Cancer Survivors Oncofertility is an important component of patient care. Our study implicates that the utilization of ART by adult survivors of childhood cancer does not put offspring at additional risk for adverse perinatal or health outcomes.

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Background Immunisation levels and attendance of preventive screening examinations indicate primary health prevention awareness. We investigated participation among German childhood cancer survivors’ (CCS’) offspring in our national offspring study. Patients and methods CCS with biological children were surveyed on their offspring’s vaccination levels and attendance of preventive screening examinations by questionnaire. Data from the German general population was available for matched-pair analysis (KiGGS study, Robert Koch-Institute, n=17,641). Results Overall, 852/1,299 (65,6%) CCS completed 1,340 questionnaires regarding their childrenʼs health. In comparison with the general population, coverage of tetanus, diphtheria and pertussis inoculations were similar (tetanus 99,1 vs. 98,4%). Measles, mumps and rubella vaccinations were carried out significantly more often by CCS’ offspring (rubella 96,1 vs. 91,7%). Throughout all age groups, preventive screening examinations were attended significantly more often by CCS’ offspring. Parentʼs anxiety regarding their offspring’s health was identified to be a confounding variable for vaccination rates. Discussion and conclusion CCS’ offspring showed comparable to significantly higher participation levels of recommended vaccinations and screening examinations than their peers from the German general population. In contrast to the general population the attendance of CCS’ offspring did not decrease with rising age. CCS’ own experiences and increased worry about their children’s health may lead to a higher prevention awareness. This should be considered in counselling parents with a cancer history.