A single-institution study evaluating the fertility of young adults with malignancy treated with immunotherapy.
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Immune checkpoint inhibitors (ICIs) are increasingly used among multiple types of cancers, but there are limited studies on the long-term effects of ICIs on fertility. Our study examines reproductive outcomes following ICI treatment and details experiences with fertility services at a single tertiary institution. A total of 184 female patients between the ages of 18-45 with documented diagnoses of malignancies were treated with ICIs from January 2012 to December 2023 at a single tertiary medical center. Demographics, oncologic, and fertility data were collected. Of 184 patients, 68 (37.0%) had documented fertility discussions prior to initiation of ICIs and 36 (19.6%) patients were referred to reproductive medicine. Of the referred patients, the median age at time of ICI therapy was 32 years. 27 (75%) were Caucasian and 6 (16.7%) were African American. The most common cancers were breast adenocarcinoma (52.8%), hematologic malignancies (25%), and melanoma (13.9%). 21 (58.3%) underwent a fertility preservation cycle (oocyte or embryo cryopreservation). There were 3 individuals with successful pregnancies. One individual used in vitro fertilization to conceive, resulting in 2 full-term live births. The other two conceived via natural conception, resulting in one full-term live birth each. Time to conception ranged from 12-27 months following ICI completion. All 3 patients underwent treatment with nivolumab, 2 of whom received chemotherapy treatment beforehand. Successful conception following treatment with immunotherapy is possible. Larger multi-institutional studies are needed to further delineate the long-term effect of ICIs on fertility.