Lai-ka Lee et al. describe spontaneous pregnancy outcomes in a cohort of 37 women who underwent stem cell transplantation for haematological malignancies in childhood. The subjects received alkylating agents (affecting ovarian function), total body irradiation (affecting ovarian and uterine function) and anthracyclines (affecting cardiac function).

There were seven spontaneous pregnancies and eight live births. Three women conceived on hormone replacement therapy. Patients conceived spontaneously with evidence of primary ovarian insufficiency and low ovarian reserve (high follicle-stimulating hormone and low anti-Müllerian hormone), which serves as a reminder that these tests are not fertility tests. One patient developed cardiac failure during pregnancy related to previous anthracycline use.

This study demonstrates the complex issues around fertility in this patient cohort. Patients should have an opportunity to discuss fertility and any risks, and be advised to use contraception if they do not want a pregnancy.

Read the full article in Clinical Endocrinology 93 466−472