Evidence to Incorporate Inclusive Reproductive Health Measures in Guidelines for Childhood and Adolescent Cancer Survivors

Sana M. Salih, Sarah Z. Elsarrag, Elizabeth Prange, Karli Contreras, Radya G. Osman, Jens C. Eikoff, Diane Puccetti

Research output: Contribution to journalArticlepeer-review

30 Scopus citations


Objective: Female childhood cancer survivors are at an increased risk of reproductive health impairment. We compared reproductive health outcomes with the recommended standard in a cohort of childhood cancer survivors. Study Design and Participants: A retrospective chart review of 222 female childhood cancer survivors aged 21years or younger that presented to a tertiary referral center between 1997-2008 was initiated. The main outcome measures were the compliance with the American Society of Clinical Oncology guidelines for childhood cancer survivor management of reproductive health. In particular, we evaluated menstrual cycle regularity, fertility preservation counseling, and endocrine profile, as defined by follicle stimulating hormone (FSH) and anti-mullerian hormone (AMH)levels as surrogate markers for ovarian reserve. Secondary outcomes were to study the contribution of survivor clinics in enforcing these guidelines. Results: Of 136 patients older than 13years at their last visit, 58 patients (43%) had FSH data available and none had AMH data. Patients were stratified into 3 groups according to FSH levels. Forty of 58 patients (69%) have normal ovarian reserve (FSH level<10), 10 of 58 patients (17%) have decreased ovarian reserve (FSH levels 10-40), and 8 of 58 patients (14%) have premature menopause, defined as FSH>40. Most patients with amenorrhea have elevated FSH levels indicating primary ovarian insufficiency, while 3 patients (2.2%) have low FSH levels consistent with hypothalamic amenorrhea. None of the patients were counseled on fertility preservation. Conclusions: Reproductive health follow-up in children with cancer, including FSH and AMH measurement when indicated, should be established and strictly adhered.

Original languageEnglish (US)
Pages (from-to)95-101
Number of pages7
JournalJournal of Pediatric and Adolescent Gynecology
Issue number2
StatePublished - Apr 1 2015
Externally publishedYes


  • Childhood cancer
  • Fertility preservation
  • Ovarian reserve
  • Reproductive health
  • Survivor clinics

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology


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