Fertility Issues Following Hematopoietic Stem Cell Transplantation

André Tichelli; Alicia Rovó

Disclosures

Expert Rev Hematol. 2013;6(4):375-388. 

In This Article

Pregnancy After HSCT

Successful pregnancies have been reported in female HSCT recipients and in female partners of male recipients. This issue was addressed in a study from the EBMT sending questionnaires to 199 centers relating to nearly 38,000 transplants. In this study 312 pregnancies were reported from 232 patients, for an overall conception rate of 0.6%.[12] In this study, recipients who had conceived via assisted reproductive technologies were included. The Bone Marrow Transplant Survivor Study reported on pregnancy outcomes on 619 women and partners of men treated with autologous or allogeneic HSCT. The median follow-up time since transplantation was 7.7 years. Thirty four patients (26 male, eight female) reported 54 pregnancies after HSCT, of which 46 resulted in live birth. Infertility was associated with older age at HSCT (≥30 years), female sex and TBI.[55] In a single center study of 708 postpubertal women receiving HSCT, 32 subsequently became pregnant (25 out of 103 with cyclophosphamide; seven out of 532 with TBI; zero out of 73 with busulfan and cyclophosphamide). The largest percentage of pregnancies occurred in patients transplanted for severe aplastic anemia.[13] A report by the Center for International Blood and Marrow Transplant Research (CIBMTR) described 178 pregnancies of HSCT recipients transplanted between 2002 and 2007. There were 83 pregnancies (with 85% live birth) in female recipients and 95 pregnancies (86% live birth), with most pregnancies occurring 5−10 years after HSCT.[56]

A recent single center questionnaire survey investigated the uptake and outcome of assisted reproductive technology and pre-transplant counseling in patients surviving a minimum of 2 years after allogeneic HSCT. After HSCT, cryopreserved material was used frequently: 60% of men with banked sperm and 62% of women with cryopreserved embryos had used stored material to attempt parenthood, when assessed a median of 11 years after transplant.[34] In a retrospective survey of the EBMT on fatherhood and cryopreservation of sperm in male patients treated with allogeneic HSCT, 14% became fathers with a median time interval since HSCT of 7.2 years (range: 1−21.6 years). Eleven of the children were conceived naturally, and 11 more by involving cryopreserved sperm.[45] From the same cohort of patients, the wish to become a father after HSCT was evaluated, demonstrating that the wish to father a child after HSCT is associated with paternity status before transplantation and the age of the patients at HSCT. The majority of patients expressing a wish to have a child after HSCT (78%) did not have children before HSCT and were young (<25 years of age).[57]

The frequency of pregnancy complications is significantly increased among female patients. Women conditioned with high-dose alkylating agents with or without TBI are likely to have an increased rate of spontaneous abortion, preterm labor and delivery and babies with low birth weight.[12–14] The aforementioned uterine damages with changes of the uterine cavity and the uterine tissue perfusion can be responsible for the increased risk of preterm delivery and low birth weight in female patients conditioned with TBI.[20] On the other hand, the infants do not appear to have a higher rate of congenital abnormalities.[12,13,58]

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