Impact of haematopoietic stem cell transplantation for benign and malignant haematologic and non-haematologic disorders on fertility: a systematic review and meta-analysis

Haematopoietic stem cell transplantation (HSCT) exposes patients to long-term complications like gonadal dysfunction and infertility. The European Society for Blood and Marrow Transplantation advised in 2015 that fertility preservation should be considered for children and adolescents requiring HSCT. This systematic review and meta-analysis is part of the FertiTOX project, which aims to close the data gap regarding the gonadotoxicity of anticancer therapies to provide more accurate advice regarding fertility preservation. This review were conducted in November 2023, covering articles since 2000. In total, 56 studies were included in the meta-analysis, comprising 1853 female malignant, 241 female benign, 1871 male malignant, and 226 male benign cases. The analysis, using a random-effects model, estimated the prevalence and its 95% confidence interval, revealing that overall infertility exceeded 30% in all groups. Female malignant cases had a prevalence of 65% (95% CI: 0.58–0.71), while in females with benign disease, it was 61% (CI: 0.48–0.73). Males with malignant disease had a prevalence of 41% (CI: 0.32–0.51), and those with benign disease had 31% (CI: 0.19–0.46). The > 30% overall prevalence indicates a clinical need for fertility preservation counseling in both genders undergoing HSCT. Further prospective studies are necessary to address HSCT’s individual impact on gonadal function. This systematic review is registered with the International Prospective Register of Systematic Reviews (PROSPERO) under CRD42023486928.