Pregnancy After Stem Cell Transplantation: What You Need To Know

Basics

oi-Shivangi Karn

By Shivangi Karn

on April 8, 2021

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.