A single-institution study evaluating the fertility of young adults with malignancy treated with immunotherapy

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.