Age At Cancer Diagnosis and Its Impact on Fertility After Systemic Oncological Treatment in Childhood, Adolescent and Young Adult (Caya) Cancer Survivors – A Systematic Review

Author(s): Charlotte Deltour, Justine Himpe, Fleur Bonny, Charlotte Smet, Lore Lapeire, Chloë De Roo

Background:

A cancer diagnosis presents unique challenges across different life stages, particularly concerning the impact of oncologic treatments on fertility in children, adolescents, and young adults. This review investigates how age at cancer diagnosis affects fertility outcomes after systemic cancer treatment.

Methods:

A systematic review was performed based on relevant literature obtained from 4 databases up until July 1st, 2024.

Results:

For women, a younger age at diagnosis generally leads to better fertility outcomes post-treatment, such as preserved ovarian function and successful pregnancies. In contrast, an older age at diagnosis is associated with diminished ovarian reserve, reduced fertility potential, and a higher risk of premature ovarian insufficiency. In men, the results are mixed. Some studies suggest that younger age at diagnosis predicts better spermatogenesis recovery post-chemotherapy, but conflicting evidence questions the protective effect of prepubertal testes against cytotoxic damage.

Conclusion:

Understanding how age at cancer diagnosis influences fertility is essential for making informed decisions about fertility preservation. The impact of age on fertility outcomes is more significant in females than males. Future research should aim to clarify the mechanisms behind age-related differences in fertility outcomes and develop personalized fertility preservation strategies for cancer survivors of all ages.