Premature ovarian insufficiency (POI) in childhood cancer survivors

Abstract The advancement in the area of cancer therapy has resulted in an overall increase in the long-term survival rate of cancer survivors, especially in children. These advances in cancer therapy also come with certain long term side effects among the adult survivors of childhood cancers, one of which is reduced fertility. The long-term effects range over a spectrum from life-altering to life-threatening, but infertility is different from others as it not only involves the patients but also their partners and family members. Premature ovarian insufficiency (POI) is one of the delayed ill effects of childhood cancer therapy. It can present as premature menopause in females who retain their ovarian function after cancer therapies. POI was mostly found among women who have previously had Hematopoietic stem cell transplantation (HSCT), abdominal irradiation, central nervous system irradiation and chemotherapy. Multiple efforts have been made to formulate screening recommendations for the late effects of cancer treatment in childhood cancer survivors. The POI surveillance recommendations for female survivors were reviewed in 2016. There still remains a wide gap in knowledge and awareness among oncology providers and the female childhood cancer survivors regarding need for surveillance of gonadal function and timely referral to gynaecologists. The discussion about this effect and counselling of available options of fertility preservation is mostly never done or is missed out. The need for a fertility status assessment at adulthood should be emphasized among most oncology providers who interact with such group of patients and timely referral to a gynaecologist/reproductive medicine specialist should be advised accordingly.