Sexuality- and Fertility-Related Issues in Women after Allogeneic Hematopoietic Stem Cell Transplantation

Abstract Background Sexual dysfunction and fertility related issues appear as major post-allogeneic hematopoietic stem cell transplantation (HSCT) late effects in young women, with a heavy impact on quality of life. Objectives The objective of our study was to evaluate the impact of disease and treatments on sexual quality of life, ovarian function and family planning initiatives in the context of allogeneic HSCT. Study design Between January 2014 to January 2016, adult female patients transplanted before age 35 and followed for more than 2 years in our center were offered to participate in the study, through a self-reported survey and/or ovarian function assessment if younger than 40 at inclusion. Results Sixty-three patients were included with a median age of 23.4 years at transplant and 30.9 years at inclusion. Twenty-nine patients (46%) were transplanted for acute leukemia and 16 (25%) for aplastic anemia. Conditioning regimen was myeloablative (MAC) in 37 patients (59%), and reduced intensity (RIC) in 26 (41%). Fifty-eight patients completed the survey and 34 were evaluated for ovarian function. Hypoestrogenism symptoms were reported by 86% of patients and changes in sexual life by 76% mainly due to low sex drive, negative impact of infertility problems, physical sequelae and loss of self-confidence. Premature ovarian failure (POF) occurred in 74% of patients and was significantly associated with conditioning regimen (MAC versus RIC plus sequential, p=0.001) and baseline disease (bone marrow failure versus acute leukemia versus others, p Conclusions Our study shows a strong impact of disease and treatments on sexual quality of life, ovarian function and family planning initiatives in the context of HSCT. It outlines the need to improve clinicians’ awareness of sexual health and fertility related issues after HSCT. The difficulty of predicting ovarian function and fertility issues after RIC pleads for wide indications of pre-transplant fertility preservation. Evaluation of the use of cryopreserved ovarian tissues is warranted.