JAAOS - 2026-07-01 - Journal Article
Fertility Outcomes in 104 Consecutive Pediatric and Young Adult High-Grade Osteosarcoma Survivors Followed Over a 45-Year Period.
Lamo-Espinosa JM, San-Julián M
Topics
Key Takeaway
Among 67 osteosarcoma survivors who desired pregnancy, only 1 of 36 women (2.7%) and 4 of 31 men (12.9%) experienced chemotherapy-attributable fertility failure over a mean follow-up of 359 months.
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Summary
This single-center retrospective study assessed fertility outcomes in 104 pediatric and young adult osteosarcoma survivors treated with standardized chemotherapy between 1980 and 2005. Of 67 survivors who desired pregnancy, 5 experienced chemotherapy-attributable fertility failure (1 woman with unspecified difficulty, 4 men with azoospermia), yielding an overall fertility impairment rate of approximately 7.5%. No significant chemotherapy dosage differences were identified between those with and without fertility complications.
Key Limitation
Fertility was assessed solely by self-reported pregnancy desire and outcome via telephone interview, with no semen analyses, hormonal assays, or gynecologic evaluations performed, making it impossible to detect subclinical gonadal dysfunction in patients who did not attempt conception.
Original Abstract
INTRODUCTION
Chemotherapy regimens in high-grade osteosarcoma have markedly improved survival rates, currently reaching approximately 70%. Concerns persist regarding a long-term effect on fertility. Despite the systematic application of many fertility preservation techniques, few studies specifically address fertility in survivors. Our goal was to assess fertility in patients treated for pediatric and young adult osteosarcoma in a long-term follow-up period.
METHODS
This study was retrospective analysis of osteosarcoma survivors treated at our center from 1980 to 2005. All followed a standardized chemotherapy protocol. In cases where contact could not be established at the time of the follow-up for their osteosarcoma, telephone interviews were conducted, querying about pregnancy desires and difficulties. In case of difficulties, we further investigated about the possible reasons behind them.
RESULTS
Of 116 consecutive patients initially enrolled, 104 were contacted; 67 (36 women, 31 men) desired pregnancy. Mean age at the beginning of treatment was 16.9 (4 to 33) years. The mean age at the end of follow-up was 46.8 (31 to 64) years, with an average follow-up period of 359 (156 to 480) months. Among the 36 women desiring pregnancy, only 1 (2.7%) faced fertility challenges due to chemotherapy. Of the 31 men desiring pregnancy, 4 (12.9%) experienced difficulties due to azoospermia secondary to chemotherapy and in two cases, the cause is unknown because no fertility studies were conducted for the couple. No discernible chemotherapy dosage differences were found between patients with fertility issues and those without.
CONCLUSIONS
Survivors of pediatric and young adult osteosarcoma exhibit a high success rate in achieving normal conception and childbirth, aligning with the general population. To inform pediatric and adolescent patients with osteosarcoma, as well as their parents, about the high success rate associated with achieving a normal conception and childbirth should be the standard.