Infertility risk perception increased in survivors of adolescent and young adult cancer

Survivors of adolescent and young adult cancer have higher rates of perceiving increased infertility risk but frequently overestimate or underestimate their risk, according to a study published online Oct. 11 in JAMA Network Open.

Hena Naz Din, Ph.D., from the University of California San Diego in La Jolla, and colleagues conducted a retrospective cohort study of female young adult survivors of cancer diagnosed between 15 and 39 years to examine whether estimated treatment gonadotoxicity and post-treatment menstrual pattern are associated with higher infertility risk perception. Data were included for 785 female participants.

The researchers found that 61.5% of the participants perceived a higher risk for infertility compared with female counterparts of their age. Higher odds of perceiving increased infertility risk were seen with prior exposure to moderate- or high- versus low-gonadotoxicity treatments (adjusted odds ratios [aORs], 2.73 and 15.39, respectively) and with amenorrhea and irregular cycles (aORs, 3.98 and 1.69, respectively).

There was minimal agreement observed for perceived increased infertility risk with objective risk (κ = 0.19). Increased odds of underestimation were seen in association with multiparity (aOR, 4.17), while lower odds of underestimation were seen in association with older age, endocrine comorbidity, and prior infertility (aORs, 0.94, 0.35, and 0.16, respectively). Lower odds of overestimation were seen in association with multiparity, breast cancer, and skin cancer (aORs, 0.48, 0.38, and 0.24, respectively).

"Strategies to reduce misalignment between perceptions and actual risk are essential to reducing psychological distress and allow for better informed reproductive decisions for adolescent and young adult cancer survivors," the authors write.

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