Successful pregnancy after allogeneic bone marrow transplant with embryos isolated before transplant.

Lipton, JH; Virro, Michael R.; Solow, H.

doi:10.1200/jco.1997.15.11.3347

Cited by 20 publications

(6 citation statements)

References 9 publications

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“…The majority of HSCT survivors are rendered infertile, however because the mean age at HSCT is 49 years this may not constitute a significant concern for many HSCT survivors. While few HSCT survivors attempt to conceive post‐transplant, many will be successful (43%), often with assisted reproductive technologies (Lipton et al , ; Demeestere et al , ; Donnez et al , ). Unfortunately such technologies are expensive and are located primarily in metropolitan areas – raising questions about equity of access.…”

Section: Discussionmentioning

confidence: 99%

A survey of fertility and sexual health following allogeneic haematopoietic stem cell transplantation in New South Wales, Australia

Dyer

Gilroy²,

Bradford

et al. 2015

Br J Haematol

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Four hundred and twenty-one adult allogeneic haematopoietic stem cell transplant (HSCT) survivors participated in a cross-sectional study to assess sexual dysfunction and infertility post-transplant. Survey instruments included the Sydney Post-Blood and Marrow Transplant (BMT) Survey, Functional Assessment of Cancer Treatment (FACT) -BMT, the Depression, Anxiety, Stress Scales (DASS 21), the Chronic Graft-versus-Host Disease (cGVHD) Activity Assessment-Patient Self Report (Form B), the Lee cGVHD Symptom Scale and The Post-Traumatic Growth Inventory. Most HSCT survivors reported sexual difficulties (51% of males; 66% of females). Men reported erectile dysfunction (79%) and decreased libido (616%) and women reported loss of libido (83%), painful intercourse (73%) and less enjoyment of sex (68%). Women also commonly reported vaginal dryness (73%), vaginal narrowing (34%) and vaginal irritation (26%). Woman had much higher rates of genital cGvHD than men (22% vs. 5%). Age and cGVHD were significantly associated with sexual dysfunction. 2Few survivors had children following transplant (33%). However, for those of reproductive age at HSCT, 22% reported trying to conceive, with 103% reporting success. This study is the largest to date exploring sexual function in survivors of allo-HSCT. These data provides the basis for health service reform to better meet the needs of HSCT survivors, including evidence to support counselling and education both pre-and post-transplant.

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Section: Discussionmentioning

confidence: 99%

A survey of fertility and sexual health following allogeneic haematopoietic stem cell transplantation in New South Wales, Australia

Dyer

Gilroy²,

Bradford

et al. 2015

Br J Haematol

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“…36,37 However, it still remains to be settled whether a uterus irradiated in childhood has the ability to grow as required during pregnancy. The impaired uterine blood flow demonstrated by us and others 21 warrants a sceptical attitude.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound B-mode changes in the uterus and ovaries and Doppler changes in the uterus after total body irradiation and allogeneic bone marrow transplantation in childhood

Holm

Nysom

Brocks

et al. 1999

Bone Marrow Transplant

115

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Summary:Internal genitalia and uterine blood flow were assessed by ultrasound in 12 females 4.0-10.9 years after total body irradiation and allogeneic bone marrow transplantation for childhood leukaemia or lymphoma. Median age of the participants was 12.7 years (range 6.1-17.6) at bone marrow transplantation and 21.5 years (11.6-25.6) at the follow-up study. At follow-up all had entered puberty and 11/12 females had experienced the menarche. Eight females received sex steroid replacement therapy, three had spontaneous pubertal development and one woman experienced symptoms of estrogen deficiency. Median uterine and ovarian volumes were significantly reduced to ؊2.6 standard deviation scores (SDS) (؊6.3 to ؊0.6), P ‫؍‬ 0.002, and ؊2.6 SDS (؊4.8 to ؊0.5), P ‫؍‬ 0.002, respectively, compared with normal controls. Follicles were only detectable in two individuals. Uterine blood flow was impaired, as a systolic blood flow could be measured in 6/9 individuals, and a diastolic blood flow in 1/9 females. Our results indicate that the prescribed dosage of hormone replacement therapy, which was sufficient to induce bleeding and suppress other stigmata of premature menopause, was inadequate to generate normal uterine growth. In order to achieve uterine growth higher doses of hormone replacement therapy may be required. Our results confirm pelvic ultrasound as a reliable tool for investigation of internal female genitalia; however, in an infertility setting further tests are indicated. Keywords: BMT; TBI; childhood; uterus; ovary; uterine blood flow During the past two decades allogeneic bone marrow transplantation (BMT) has been used in the treatment of children with relapsed or very high risk leukaemia and lymphoma. Since many of these children become long-term survivors, the late effects of treatment are of major concern. Preparative regimens for BMT, high-dose chemotherapy alone or in combination with total body irradiation (TBI), may cause various endocrine abnormalities, 1-10 and ovarian failure Correspondence: K Holm, Department of Growth and Reproduction, Section 5064, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark Received 26 March 1998; accepted 5 September 1998 resulting in life-long need for sex steroid replacement therapy (HRT) and infertility is common. Recovery of ovarian function occurs especially when preparative regimens do not include TBI, 5-11 and cases of pregnancies resulting in successful deliveries have been reported even when preparative regimens have included TBI. [12][13][14][15][16][17][18][19][20] The progress of assisted reproduction and the availability of oocyte donation has made pregnancy a possibility in women without ovarian function, provided there is normal function of the uterus. However, once pregnancy has been achieved, other problems may occur. In patients treated for solid tumours abdominal irradiation with 20-30 Gy have caused irreversible damage to uterine musculature and blood flow 21 and a high risk of adverse pregnancy outcome, eg low birth weight and increased perinat...

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“…Uterine blood flow was impaired, and these observations have serious implications for possible fertility after oocyte donation in these women [52, 55, 56]. …”

Section: Therapymentioning

confidence: 99%

Impact of Cancer Therapy on the Reproductive Axis

Müller

2003

Horm Res Paediatr

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Cancer therapy includes surgery, chemotherapy and irradiation. Depending on the diagnosis, the location of the neoplasm and the age of the patient, these treatment modalities may be given alone or in combination. All forms of cancer therapy can affect the hypothalamic-pituitary-gonadal axis. The long-term consequences for reproductive function depend on several aspects. The sex of the patient is important, since ovarian and testicular function differ significantly. Sex hormone production in the female is dependent on the presence of germ cells, whereas this is not the case in the male. The sensitivity of germ cells to cancer therapy also differs between the sexes. Moreover, the sensitivity of both the hypothalamic-pituitary axis and the gonads is highly age dependent. With regard to chemotherapy, the possible damage to the gonads is dependent on the total dose and type of agent given. According to current knowledge, the hypothalamic-pituitary axis is not affected by conventional doses of chemotherapy. Radiotherapy has by far the most damaging effect on the reproductive axis, having serious adverse effects on both the hypothalamic-pituitary area as well as on the gonads themselves. The harmful effect of irradiation depends on the total dose of irradiation, the radiation field, as well as the number and size of fractions given. The long-term consequences of recently introduced radiotherapeutic methods such as stereotactic irradiation are not yet known. The present review will focus on the late effects of cancer therapy in children and young adults with acute lymphoblastic leukaemia, non-Hodgkin’s lymphoma, brain tumour, Hodgkin’s lymphoma or Wilms’ tumour, including the adverse effects of bone marrow transplantation.

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Successful pregnancy after allogeneic bone marrow transplant with embryos isolated before transplant.

Abstract: Our experience offers a fertility-salvaging technique to some women after cytotoxic therapy, where time permits ovarian hyperstimulation before the need for definitive myeloblative therapy of their malignancy, and where the risk of subsequent infertility is high.

Cited by 20 publications

References 9 publications

A survey of fertility and sexual health following allogeneic haematopoietic stem cell transplantation in New South Wales, Australia

A survey of fertility and sexual health following allogeneic haematopoietic stem cell transplantation in New South Wales, Australia

Ultrasound B-mode changes in the uterus and ovaries and Doppler changes in the uterus after total body irradiation and allogeneic bone marrow transplantation in childhood

Impact of Cancer Therapy on the Reproductive Axis

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