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Pregnancy After Stem Cell Transplantation: What You Need To Know
Pregnancy after stem cell transplant has often been a subject of concern and received much attention. A study has shown that the success of getting pregnant after stem cell transplantation depends on many factors such as the doses of radiation and chemotherapy, and maternal age during the transplantation.
In this article, we will discuss pregnancy outcomes after stem cell transplantation. Take a look.
What Is Stem Cell Transplantation?
Stem cell transplantation is a procedure in which healthy stem cells are administered to patients with dysfunctional or depleted bone marrow. This process helps improve bone marrow functionality and allows either killing of the cancerous cells or the generation of healthy cells to replace those that are dysfunctional. [1]
To mention, stem cells are those special cells in the body that have the ability to develop into any cell types in an organism and can also self-renew themselves, while bone marrow is a soft tissue in the centres of the bones that manufactures and store stem cells.
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Stem cell transplantation can increase the survival rate in patients with haematological or blood-related malignancies, immune-deficiency syndrome or other diseases.
Why Is Pregnancy After Stem Cell Transplant Difficult?
Women who have undergone or going to start with stem cell transplantation are often concerned about their fertility and chances of getting pregnant after the procedure.
Though transplantation helps increase the survival rate in people with certain cancer types such as leukaemia or lymphoma, the patients often experience fertility issues due to damage to the reproductive organs such as ovaries by the pretransplant conditioning protocols.
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These protocols include the use of alkylating agents, radiation, or both which have toxic effects on the body. [2]
Also, even if a woman manages to get pregnant naturally or mechanically by in-vitro fertilization methods, there is an increased risk of low birth weight, prematurity, abortion or other pregnancy complications.
Can The Damage Be Reversed?
Damage caused due to stem cell transplantation to women can make them permanently infertile, while others can regain their fertility. The regaining of fertility depends on many factors such as:
- Age during the time of first treatment
- The number of cycles with irradiation and alkylating agents.
Studies say that use of both the methods i.e. alkylating agents and irradiation combined can cause more damage to the fertility of women compared to the use of a single method for the treatment. [3]
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Also, the rate of recovery is higher, around 79 per cent, in women who have age less than 25 and have not undergone the full-body irradiation regimens with no immunosuppressive therapy, compared to those whose age was more and have received total body irradiation. [4]
Case Studies
Here are a few case studies which will talk about women who have undergone stem cell transplantation and their pregnancy. [5]
Case
1:
A
22-year-old
nulliparous
female
was
presented
with
stage
III
Hodgkin's
disease.
She
has
undergone
six
cycles
of
chemotherapy,
followed
by
stem
cell
transplantation.
Result:
She
conceived
on
hormone
replacement
therapy
(HRT)
after
two
years
of
replacement
therapy
and
delivered
a
healthy
boy
vaginally.
Case
2:
A
28-year-old
nulliparous
woman
was
presented
with
stage
Hodgkin's
disease.
She
has
undergone
treatment
with
six
cycles
of
ABVD
(adriamycin,
bleomycin,
velban,
and
DTIC),
followed
by
stem
cell
transplantation.
Result:
She
was
placed
on
HRT
for
three
months
and
conceived
after
six
months
and
delivered
a
baby
girl
vaginally.
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Case
3:
A
30-year-old
woman
diagnosed
with
stage
III
breast
carcinoma.
She
underwent
five
cycles
of
chemotherapy,
followed
by
stem
cell
transplantation.
Result:
The
patient
conceived
after
one
and
a
half
years
after
the
transplantation.
However,
due
to
certain
possible
adverse
effects
of
the
therapy,
the
pregnancy
was
aborted
in
the
first
trimester
due
to
the
effect
of
tamoxifen.
Case
4:
A
41-year-old
woman
was
diagnosed
with
ductal
carcinoma.
She
was
treated
with
four
cycles
of
chemotherapy,
followed
by
bone
marrow
transplantation.
Result:
After
16
months,
the
woman
conceived,
however,
the
pregnancy
was
aborted
in
the
second
trimester
due
to
the
effect
of
tamoxifen.
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To Conclude
Women who receive total body irradiation should be treated as a high-risk group as the chances of pregnancy is quite low in those women. Also, the chances of abortion in stem cell treated women is higher.
Studies are carried out in the area to develop alternative therapy regimens with lower doses of alkylating agents so that the damage done to the fertility is less or such that can be reversed easily.
In this way, women who wish to become pregnant after stem cell transplantation can successfully do that without any complications or without spending on mature oocyte cryopreservation, a method in which eggs are harvested from ovaries, frozen and stored for later use.
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