Infertility, the outcomes of assisted reproductive technologies use in childhood cancer survivors: a scoping review.

PURPOSE: Childhood cancer survivors (CCS) are at increased risk of treatment-related infertility and may require assisted reproductive technologies (ART) to achieve parenthood. This scoping review aimed to synthesise the existing scientific evidence on the use of ART among CCS, focusing on fertility outcomes and associated maternal, perinatal, and child health indicators.

METHODS

Adapted from Joanna Briggs Institute (JBI) and PRISMA-ScR guidelines, MEDLINE (OVID), CINAHL, and Embase were searched (conducted from the inception of each database up to February 2025) for studies of CCS diagnosed before age 18, surviving ≥ 5 years, and reporting ART-related fertility, obstetric, or perinatal outcomes. Screening and extraction were conducted independently via Covidence.

RESULTS

From 4,785 records, 10 studies met the inclusion criteria. Five studies reported higher infertility rates among female CCS (4.5-34%) compared with non-cancer controls. ART success rates were generally comparable to siblings, though pelvic or cranial radiotherapy reduced live birth rates by 17-32%. Three studies demonstrated the feasibility of ovarian tissue cryopreservation (OTC), particularly for prepubertal girls. Male CCS were more likely to require intracytoplasmic sperm injection (ICSI) and had lower ART success than non-cancer siblings. Neonatal studies found increased multiple gestations, preterm births, and low birth weight among ART-conceived offspring, but no rise in congenital anomalies or childhood cancer.

CONCLUSION

ART enables parenthood for childhood cancer survivors, though prior gonadotoxic therapies can impair success and increase perinatal risks, highlighting the need for long-term survivorship research.

IMPLICATIONS FOR CANCER SURVIVORS: ART provides viable fertility options, but early counseling and integrated reproductive care are essential to optimise outcomes and ensure equitable access for all cancer survivors.