小儿癌症治疗暴露会降低卵巢储备。然而，女性幸存者在辅助生殖技术（ART）方面的成功尚未得到充分证实。我们将研究的小儿癌症幸存者与美国辅助生殖技术协会的诊所结果报告系统相连，该系统记录了全国辅助生殖技术的结果。作者使用广义估计方程考虑个体多次卵巢刺激的情况，评估了存活婴儿的比率、相对风险（RR）以及与治疗暴露的关联。我们从一部分幸存者随机样本中招募了兄弟姐妹作为对照组。在9885名女性幸存者中，有137人（1.4%；诊断时的中位年龄为10岁，范围为0-20岁；18岁后随访的中位年限为11年，范围为2-11年）通过自体或捐助卵子和/或妊娠保姆进行了224次卵巢刺激（157次自体卵巢刺激周期，67次捐助卵子刺激周期）。在兄弟姐妹中，有33人（1.4%）进行了51次自体或捐助卵子刺激。在未使用妊娠保姆的情况下，使用自体卵子的胚胎的幸存者中，有97人进行了155次刺激，结果有49个婴儿存活，每次卵巢刺激的存活率为31.6%（兄弟姐妹的存活率为38.3%；p = 0.39），每次胚胎移植的存活率为43.9%（兄弟姐妹的存活率为50.0%；p = 0.33）。与兄弟姐妹相比，经过颅部放射治疗（RR为0.44；95% CI为0.20-0.97）和骨盆放射治疗（RR为0.33；95% CI为0.15-0.73）的幸存者的存活机会降低。ART治疗后的存活概率在接受烷化剂治疗（环磷酰胺当量剂量≥8000mg/m2与无治疗；RR为1.04；95% CI为0.52-2.05）的幸存者中未受影响。小儿癌症幸存者进行ART治疗的概率与兄弟姐妹对照组相同。烷化剂暴露后ART治疗的成功率未降低。当前研究结果为该人群使用ART提供了必要的指导。© 2023美国癌症学会。

Treatment exposures for childhood cancer reduce ovarian reserve. However, the success of assisted reproductive technology (ART) among female survivors is not well established.Five-year survivors of childhood cancer in the Childhood Cancer Survivor Study were linked to the Society for Assisted Reproductive Technology Clinic Outcome Reporting System, which captures national ART outcomes. The authors assessed the live birth rate, the relative risk (RR) with 95% confidence intervals (95% CIs), and associations with treatment exposure using generalized estimating equations to account for multiple ovarian stimulations per individual. Siblings from a random sample of survivors were recruited to serve as a comparison group.Among 9885 female survivors, 137 (1.4%; median age at diagnosis, 10 years [range, 0-20 years]; median years of follow-up after age 18 years, 11 years [range, 2-11 years]) underwent 224 ovarian stimulations using autologous or donor eggs and/or gestational carriers (157 autologous ovarian stimulation cycles, 67 donor ovarian stimulation cycles). In siblings, 33 (1.4%) underwent 51 autologous or donor ovarian stimulations. Of those who used embryos from autologous eggs without using gestational carriers, 97 survivors underwent 155 stimulations, resulting in 49 live births, for a 31.6% chance of live birth per ovarian stimulation (vs. 38.3% for siblings; p = .39) and a 43.9% chance of live birth per transfer (vs. 50.0%; p = .33). Prior treatment with cranial radiation therapy (RR, 0.44; 95% CI, 0.20-0.97) and pelvic radiation therapy (RR, 0.33; 95% CI, 0.15-0.73) resulted in a reduced chance of live birth compared with siblings. The likelihood of live birth after ART treatment in survivors was not affected by alkylator exposure (cyclophosphamide-equivalent dose, ≥8000 mg/m2 vs. none; RR, 1.04; 95% CI, 0.52-2.05).Childhood cancer survivors are as likely to undergo treatment using ART as sibling controls. The success of ART treatment was not reduced after alkylator exposure. The results from the current study provide needed guidance on the use of ART in this population.© 2023 American Cancer Society.