Reproductive considerations in patients undergoing treatment for complex lymphatic anomalies

Complex lymphatic anomalies (CLAs) are a spectrum of lymphatic malformations affecting multiple organ systems. These disorders are characterized by a wide variability in presentation features, which often delays accurate diagnosis and complicates characterization and differentiation. Little is known about the gynecologic and reproductive effects of CLAs or their associated treatments, such as long term systemic immunosuppressive medications and repurposed single molecule inhibitors. In this case report, we discuss a patient presenting for gynecologic and fertility preservation consult in the setting of treatment for CLA. The subsequent fertility preservation cycle resulted in a suboptimal yield, illustrating the need for early involvement of reproductive endocrinologists in the care of these patients prior to any potential decline in their ovarian reserve. Further studies are needed to evaluate the effect of disease and medications on reproductive health and female fertility.