What type of study is this?

This is a Meta-Analysis study (also classified as: Systematic Review).

What question did this study set out to answer?

Assess the effects of cancer treatment on fertility in female survivors of childhood and adolescent cancers.

February 14, 2026BMC Cancer0 citationsOpen Access

Impact of cancer treatment on fertility in female childhood and adolescent cancer survivors: a systematic review and meta-analysis

MWMin WangGuangdong Polytechnic Normal University LCLijian CaoChildren's Hospital of Chongqing Medical University YZYunlong ZhangChildren's Hospital of Chongqing Medical University

Key Points

Assess the effects of cancer treatment on fertility in female survivors of childhood and adolescent cancers.
Conducted a systematic literature search in PubMed and other databases.
Included cohort, case-control, and cross-sectional studies published in English or Chinese.
Analyzed 20 qualifying studies involving 7,217 patients using Review Manager 5.4 software.
Fertility impairment risk in female survivors significantly increased versus non-treated population (OR: 5.55).
Survivors with hematologic malignancies showed an elevated risk of impaired fertility (OR: 3.98).
Risk heightened with higher doses of alkylating agents (>8000 mg/m2, OR: 8.29) and ovarian radiation exposure (OR: 43.40).

Abstract

With the improvement of the survival rate of children with caners, increasing attention is being paid to their long-term quality of life, especially the fertility concerns of female survivors. Here, we assess the impact of cancer treatment on the fertility in female childhood and adolescent cancer survivors. To identify relevant studies, a systematic literature search was performed in PubMed, Medline, Embase, and other databases. The search focused on treatment-related fertility impairment in pediatric or adolescent cancer patients and included cohort, case–control, and cross-sectional studies. Only articles published in Chinese or English, spanning from database inception to July 29, 2024, were retrieved. Review Manager 5.4 software was employed for the meta-analysis. Following screening of 945 records, 20 studies met the inclusion criteria, yielding a final cohort of 7,217 patients.The synthesis results indicated that the impaired risk of fertility in female childhood and adolescent cancer survivors was significantly increased versus the population without cancer treatment (OR: 5.55, 95% CI: 2.38–12.89, P < 0.001). The survivors with hematologic malignancies had an elevated risk of impaired fertility (OR: 3.98, 95% CI: 1.18–13.45, P < 0.05). And, the risk in the survivors was significantly higher with alkylating agent doses greater than 8000 mg/m 2 (OR: 8.29, 95% CI: 3.16–21.77, P < 0.001), Ovaries within the radiation field (OR: 43.40, 95% CI: 26.08–72.22, P < 0.001), and stem cell transplantation (SCT) (OR: 16.07, 95% CI: 8.00–32.29, P < 0.001). Furthermore, the survivors who received cancer treatment after puberty had the elevated risk (OR: 1.88, 95% CI: 1.23–2.88, P < 0.001). In contrast, treatment before puberty was not associated with a significantly increased risk in this cohort. For female childhood cancer patients undergoing cancer treatment, alkylating agents, ovarian exposure to radiation therapy, and SCT all elevated the impaired risk of fertility. Therefore, effective fertility preservation measures should be proactively provided to this population to mitigate the fertility damage associated with cancer treatments and protect the fertility function of female childhood cancer survivors. PROSPERO registration number: CRD420250655189.

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