Reproductive patterns and birth rates in acute leukaemia survivors: A Danish population-based cohort study

Treatment-related infertility is of great concern to younger long-term survivors of acute leukaemia (AL). This study aimed to assess birth rates and cumulative incidences of first live birth, use of assisted reproduction technology (ART) and pregnancy outcomes in AL survivors compared to the Danish general population. Patients aged 18-45 years at AL diagnosis, alive and in remission 3 years after the date of diagnosis (index date), were included and matched 1:10 with leukaemia-free comparators on sex, age and parenthood status. A total of 401 AL survivors (183 females; 218 males) and 4010 matched comparators were followed for a median of 9.9 years. The median age at index was 37 years in females and 36 years in males. AL survivors had lower birth rates (incidence rate ratio: 0.77, 95% confidence interval: 0.61-0.99), lower 10-year cumulative incidences (females: 20.1% vs. 27.8%; males: 22.3% vs. 29.9%), a higher use of ART (females: 25.5% vs. 14.1%; males: 55.9% vs. 12.2%), but no higher degree of adverse pregnancy outcomes. This underscores the importance of informing patients of fertility-preservation options as well as of the risk of treatment-related infertility.