ESPE Yearbook of Paediatric Endocrinology

randi.lykke-sylvest@regionh.dk Human Reproduction, Vol.36, No.9, pp. 2576–2586, 2021. PMID: 34166497.

Brief Summary: This Danish register-based cohort study investigated the rate of fatherhood among 9,353 men diagnosed with cancer during childhood or early adulthood (CSs), compared with 1,386,493 age-matched males without cancer. CSs became fathers slightly less frequently than controls (36% versus 42%).

CSs were divided according to diagnosis (central nervous system, CNS, tumours, haematological cancer or solid tumours), age at diagnosis/study entry (<9, 10-19 and 20-29 years) and year of diagnosis/study entry (4 decades, from 1978 to 2016). Survivors became fathers less frequently than controls (36% versus 42%); in particular, fatherhood least frequent in survivors of CNS cancer (hazard ratio (HR)=0.67) and highest in solid cancer survivors (1.16). The outcome in CNS survivors was correlated with a higher rate of adverse effects (clinical, psychological and psychosocial) related to both cancer specific characteristics and its treatment. Fatherhood in lymphoma survivors was higher than in leukaemia survivors (HR 0.92 versus 0.71), probably due to different therapeutic strategies, but unfortunately this data was lacking. Moreover, HR increased in patients with higher age at cancer diagnosis and in patients diagnosed in recent decades. The trend in improvement of HR over time was confirmed in all cancers, and it was already evident shortly after diagnosis.

In the last few years many techniques of cryopreservation (semen for post-pubertal patients, testicular tissue for pre-pubertal patients) have been developed and the fatherhood desire represents now an important issue to be discussed at the moment of cancer diagnosis.

These results are encouraging in comparison with previous reports. Time trends indicate that a higher proportion of men with a cancer diagnosis during childhood are now able to become fathers, confirming that their life conditions have improved over time. A multidisciplinary team involving fertility specialists and oncologists should be involved in the evaluation of fertility risk at cancer diagnosis and during follow up, in order to ensure and prioritise individualized fertility counselling.