Table 8.
Sexual Health, Fertility and Pregnancy
| Recommendation | Grade | Ref | Comments |
|---|---|---|---|
| • Discuss sexual function with patients at 3-6 months post-HCT and annually thereafter. | 2A | [393–396] | • Potentially modifiable symptoms: genital cGVHD, ED, vaginal dryness/dyspareunia, relationship quality, treatment related distress, depression. • Screening/managing sexual dysfunction includes individualized multimodal approach addressing medical and psychosocial (including partner) needs. |
| • Timely assessments of hypogonadism and/or urogenital GVHD. | 2A | [393] | • GYN/GU referrals to address reversible risk factors relevant to sexual dysfunction. • POI is treated with HRT if not otherwise contraindicated. • Refer women with vaginal dryness ± cGVHD to GYN/GU; may benefit from lubricants, topical estrogens, dilator therapies. • Consider ED therapies, testosterone replacement in males. |
| • Patients desiring pregnancy should meet with a fertility specialist to best understand current fertility potential and what methods (ie, IVF, donor oocyte, donor sperm) may be considered if applicable. • Semen analysis or assessment of ovarian function for those contemplating future parenthood when age appropriate. |
2A | [393] | • Reassess fertility potential at intervals; partial or full fertility potential may recover for some patients. |
| • Contraception advised if fertility potential unknown, wishing to avoid parenthood. • Counseling regarding safer sex practices/contraception should be discussed, even if infertile, to prevent sexually transmitted infections. |
2A | ||
| • Women with gonadal recovery should be advised about the risks of POI. | 2A | ||
| • Pregnant patients should be followed by MFM (high-risk obstetrics). | 2A | [393] | • May require review by an anesthetist before delivery. |
| • Pregnant women with systolic dysfunction/significant cardiac risk factors to be followed by cardiologist with expertise in cardiac late effects. | 2A | [196,393] | |
| • Counsel women who received radiation to the uterus (including TBI) and desire pregnancy on risk of uterine factor infertility, other pregnancy risks. | 2A | ||
| • Offer genetic counseling before pregnancy to those undergoing HCT for genetic disorder or cancer predisposition syndrome | 2A |