Association of platinum-based chemotherapy with live birth and infertility in female survivors of adolescent and young adult cancer

Objective Lack of treatment-specific fertility risks for female survivors of adolescent and young adult cancer limits counseling on fertility preservation decisions. The objective was to estimate the effect of platinum-based chemotherapy on live birth and infertility after cancer. Design Retrospective cohort study using U.S. administrative data Participants We identified incident breast, colorectal and ovarian cancer cases in females ages 15-39 who received platinum-based chemotherapy or no chemotherapy and matched them to females without cancer. Exposure Platinum-based chemotherapy Outcomes We estimated the effect of chemotherapy on incidence of live birth and infertility after cancer, overall and after accounting for competing events (recurrence, death, sterilizing surgeries). Results There were 1,287 survivors in the chemotherapy group, 3,192 survivors in the no chemotherapy group, and 34,147 women without cancer, mean age 33. Accounting for competing events, overall five-year live birth incidence was lower in the chemotherapy group (3.9%) versus the no chemotherapy (6.4%) group. Adjusted relative risks versus no chemotherapy and no cancer were 0.61 (95%CI 0.42-0.82) and 0.70 (95%CI 0.51-0.93), respectively. Overall five-year infertility incidence was similar in the chemotherapy group (21.8%) compared to no chemotherapy group (20.7%). The adjusted relative risks versus no chemotherapy and no cancer were 1.05 (95%CI 0.97-1.15) and 1.42 (95%CI 1.31-1.53), respectively. Conclusions and relevance Cancer survivors treated with platinum-based chemotherapy experienced modestly increased adverse fertility outcomes. Estimated effects of platinum-based chemotherapy were affected by competing events, suggesting the importance of this analytic approach for interpretations that ultimately inform clinical fertility preservation decisions.