---
title: "Childbirth Rates Among Female Cancer Survivors in Taiwan: Nationwide Population Study"
id: "plos-one-0-rates-of-childbirth-in-female-cancer-survivors-a-population-based-study-in"
canonical_url: "https://medichelpline.com/clinical-feed/plos-one-0-rates-of-childbirth-in-female-cancer-survivors-a-population-based-study-in"
content_type: "clinical_feed_article"
specialty: "Oncology"
source_name: "PLOS ONE (Medicine)"
source_url: "https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358466"
published_at: "2026-09-11T14:00:00.000Z"
evidence_level: "Journal Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Childbirth Rates Among Female Cancer Survivors in Taiwan: Nationwide Population Study
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/plos-one-0-rates-of-childbirth-in-female-cancer-survivors-a-population-based-study-in
- **Specialty:** [Oncology](https://medichelpline.com/clinical-feed/oncology.md)
- **Primary Source:** PLOS ONE (Medicine)
- **Source URL:** [Original Journal Publication](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358466)
- **Published At:** 2026-09-11T14:00:00.000Z
- **Evidence Rating:** Journal Feed
## Executive GIST (TL;DR)
- This population-based cohort linked Taiwan’s Cancer Registry, Birth Reporting Registry, and Death Registry to follow 72,929 females diagnosed with cancer at age ≤39 years for post-diagnosis livebirths. - Overall, **9.8%** of these survivors had at least one livebirth after diagnosis; cumulative incidences of first post-diagnosis livebirth were **6.4%** at 5 years, **10.7%** at 10 years, and **13.9%** at 15 years. - Compared with the general female population, survivors had about half the expected number of births (Standardized Birth Ratio **SBR = 0.50**, 95% CI 0.49–0.51), indicating substantially reduced childbearing at the population level. - There was marked heterogeneity by cancer type: childbirth was relatively preserved after **thyroid** and **skin** cancers but markedly reduced for **cervical, uterine, breast, leukemia,** and **central nervous system** cancers. - Older age at diagnosis and receipt of **chemotherapy** were strongly associated with a lower likelihood of subsequent childbirth in multivariable cause-specific Cox models. - The study excluded births occurring within one year of diagnosis and started follow-up at diagnosis (or at age 15 for those diagnosed younger), censoring at first livebirth, age 49, death, or end of 2023. - Data spanned cancer diagnoses recorded in the Taiwan Cancer Registry (1979–2022), births from the Birth Reporting Registry (2001–2023), and deaths through 2023. - Authors highlight the need for early fertility counseling and improved access to oncofertility services; Taiwan introduced a national fertility preservation subsidy program in September 2025 for certain patients, which the authors note as a relevant policy context. - Datasets are not publicly shareable due to legal and ethical restrictions; access can be requested through Taiwan’s Health and Welfare Data Science Center subject to review and ethics approval. - The study provides robust, population-level evidence from an Asian setting that childbearing after cancer is substantially reduced and varies by cancer type, age at diagnosis, and treatment.
## Clinical Analysis & Structured Key Points
[ Skip to main content ](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358466#main-content) Advertisement * [plos.org](https://plos.org/) * [Create account](https://community.plos.org/registration/new) * [Sign in](https://journals.plos.org/user/secure/login?page=%2Fplosone%2Farticle%3Fid%3D10.1371%2Fjournal.pone.0358466) * * About * Browse * Publish * [](https://journals.plos.org/plosone/ "PLOS One") * Search [advanced search](https://journals.plos.org/plosone/search) * [Browse Topics](https://journals.plos.org/plosone/subjectAreaBrowse) Browse Subject Areas ? Click through the PLOS taxonomy to find articles in your field. For more information about PLOS Subject Areas, click [here](https://github.com/PLOS/plos-thesaurus/blob/master/README.md "Link opens in new window"). [](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358466) [](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358466) * 0 [Save](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0358466#savedHeader) [Total Mendeley and Citeulike bookmarks.](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0358466#savedHeader) * 0 [Citation](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0358466#citedHeader) [Paper's citation count computed by Dimensions.](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0358466#citedHeader) * 0 [View](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0358466#viewedHeader) [PLOS views and downloads.](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0358466#viewedHeader) * 0 [Share](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0358466#discussedHeader) [Sum of Facebook, Twitter, Reddit and Wikipedia activity.](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0358466#discussedHeader) Open Access Peer-reviewed Research Article # Rates of childbirth in female cancer survivors: A population-based study in Taiwan * Ya-Ling Hsieh, Roles Conceptualization, Methodology, Writing – original draft Affiliations Nursing Department, Chi Mei Medical Center, Tainan, Taiwan, Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan ⨯ * Chia-Jung Chiang, Roles Investigation, Writing – review & editing Affiliations Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital Tainan Branch, Tainan, Taiwan ⨯ * Tsung Yu Roles Conceptualization, Formal analysis, Funding acquisition, Investigation, Methodology, Writing – original draft, Writing – review & editing * E-mail: tsungyu@mail.ncku.edu.tw Affiliation Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0002-5773-3665 ](https://orcid.org/0000-0002-5773-3665 "ORCID Registry") ⨯ # Rates of childbirth in female cancer survivors: A population-based study in Taiwan * Ya-Ling Hsieh, * Chia-Jung Chiang, * Tsung Yu ![PLOS](https://journals.plos.org/resource/img/logo-plos-full-color.svg) x * Published: September 11, 2026 * * [Article](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358466) * [Authors](https://journals.plos.org/plosone/article/authors?id=10.1371/journal.pone.0358466) * [Metrics](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0358466) * [Comments](https://journals.plos.org/plosone/article/comments?id=10.1371/journal.pone.0358466) * [Media Coverage](http://plos.altmetric.com/details/doi/10.1371/journal.pone.0358466) * [Peer Review](https://journals.plos.org/plosone/article/peerReview?id=10.1371/journal.pone.0358466) * [Abstract](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358466#abstract0) * [Introduction](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358466#sec005) * [Methods](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358466#sec006) * [Results](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358466#sec010) * [Discussion](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358466#sec014) * [Supporting information](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358466#sec015) * [Acknowledgments](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358466#ack) * [References](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358466#references) * [Reader Comments](https://journals.plos.org/plosone/article/comments?id=10.1371/journal.pone.0358466) * [Figures](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358466) ## Abstract ### Background As cancer survival improves, increasing numbers of women diagnosed during their reproductive years face potential fertility impairment. However, population-based evidence on post-cancer childbearing remains limited in Asian settings. ### Methods We conducted a nationwide cohort study in Taiwan by linking the Cancer Registry, Birth Reporting Registry, and Death Registry. A total of 72,929 females diagnosed with cancer at age ≤ 39 years were followed to identify subsequent livebirths. The cumulative incidence of first post-diagnosis livebirth was estimated using competing-risk methods. Predictors were evaluated using cause-specific Cox models. Standardized birth ratios (SBRs) were calculated by comparing observed births with expected births in the general population, standardized by age and calendar year. ### Results Overall, 9.8% of female cancer survivors had at least one livebirth after diagnosis. The 5-, 10-, and 15-year cumulative incidences were 6.4%, 10.7%, and 13.9%, respectively. Compared with the general population, survivors had approximately half the expected number of births (SBR = 0.50; 95% CI, 0.49–0.51). Substantial heterogeneity was observed across cancer types: childbirth was most preserved among survivors of thyroid and skin cancers, whereas those with cervical, uterine, breast, leukemia, and central nervous system cancers had markedly reduced childbirth. Older age at diagnosis and receipt of chemotherapy were strongly associated with lower likelihood of childbirth. ### Conclusions In this large, nationwide study, female cancer survivors in Taiwan experienced substantially reduced childbirth rates, with pronounced variation by cancer type, age at diagnosis, and treatment. These findings provide robust population-level evidence from an Asian context and highlight the need for early fertility counseling and improved access to oncofertility care. ## Figures ![Table 4](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0358466.t004) ![Table 1](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0358466.t001) ![Table 2](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0358466.t002) ![Table 3](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0358466.t003) ![Table 4](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0358466.t004) ![Table 1](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0358466.t001) ![Table 2](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0358466.t002) ![Table 3](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0358466.t003) **Citation:** Hsieh Y-L, Chiang C-J, Yu T (2026) Rates of childbirth in female cancer survivors: A population-based study in Taiwan. PLoS One 21(9): e0358466. https://doi.org/10.1371/journal.pone.0358466 **Editor:** Chong-Chi Chiu, E-Da Cancer Hospital, TAIWAN **Received:** April 9, 2026; **Accepted:** September 1, 2026; **Published:** September 11, 2026 **Copyright:** © 2026 Hsieh et al. This is an open access article distributed under the terms of the [Creative Commons Attribution License](http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. **Data Availability:** Access to the data is subject to ethical and legal restrictions imposed by the data custodian and relevant Institutional Review Boards, in accordance with Taiwan’s Personal Data Protection Act. As a result, the dataset cannot be publicly shared. Researchers interested in accessing the data may apply through the Health and Welfare Data Science Center ([https://dep.mohw.gov.tw/DOS/cp-5119-59201-113.html)](https://dep.mohw.gov.tw/DOS/cp-5119-59201-113.html). Access is granted upon review of a research proposal and documentation of ethics approval. Alternatively, access can be requested from the following Health and Welfare Data Science Center, Ministry of Health and Welfare (Taiwan) contacts: Mr. Cao Tel: +886-2-8590-6809 Email: sttony123@mohw.gov.tw Ms. Lin Tel: +886-2-8590-6812 Email: stlh@mohw.gov.tw Mr. Zheng Tel: +886-2-8590-6815 Email: stzxc3476@mohw.gov.tw. **Funding:** The author(s) received no specific funding for this work. **Competing interests:** The authors have declared that no competing interests exist. ## Introduction Cancer can be diagnosed during childhood and the reproductive years. In 2022, a total of 62,994 new cancer cases were diagnosed among females in Taiwan. Of these, 170 occurred in children aged 0–14 years and 4,036 in adolescents and young adults aged 15–39 years, representing 6.7% of all new diagnoses [[1](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358466#pone.0358466.ref001)]. With continued advances in cancer detection and treatment, survival has markedly improved in Taiwan: the 5-year survival rate for females increased from 53.2% among those diagnosed in 2002 to 65.5% among those diagnosed in 2018 [[2](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358466#pone.0358466.ref002)]. As more patients live beyond their diagnosis, growing numbers of childhood, adolescent, and young adult cancer survivors face long-term and late effects of the cancer and treatment, including chronic health conditions, secondary malignancies, impaired fertility, psychosocial challenges, and financial toxicity [[3](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358466#pone.0358466.ref003)–[5](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358466#pone.0358466.ref005)]. Fertility is a central concern for individuals diagnosed with cancer during their reproductive years. Many cancer-related treatments—including chemotherapy, radiotherapy, and surgical procedures—can substantially compromise reproductive function. Accordingly, early integration of fertility preservation into treatment planning and survivorship care is critical [[6](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358466#pone.0358466.ref006)]. The American Society of Clinical Oncology (ASCO) 2025 guideline offers comprehensive, evidence-based recommendations for both adult and pediatric populations. It strongly emphasizes the need for clinicians to discuss potential infertility risks before treatment begins, provide timely referrals to reproductive specialists, and present age- and sex-appropriate fertility preservation options [[7](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358466#pone.0358466.ref007)]. Although these recommendations underscore the importance of preserving reproductive potential as a fundamental component of cancer care for young patients, evidence on long-term reproductive outcomes across different populations is still needed. For example, population‐based studies from Western countries consistently demonstrate reduced childbearing among cancer survivors. A Swedish registry study reported a 27% lower likelihood of childbirth among survivors compared with the general population [[8](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358466#pone.0358466.ref008)], while data from Scotland showed a 38% reduction in the probability of subsequent pregnancy [[9](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358466#pone.0358466.ref009)]. In the United States, a study of female adolescent and young adult survivors in North Carolina found that their birth rate was only 55% of that of age- and race-matched women without cancer [[10](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358466#pone.0358466.ref010)]. But comparable data from Asian populations, including Taiwan, remain limited. In Taiwan, to strengthen reproductive support for cancer patients and reduce financial barriers, the Ministry of Health and Welfare launched a national pilot fertility preservation subsidy program in September 2025 [[11](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358466#pone.0358466.ref011)]. Previously, subsidies for fertility preservation related to iatrogenic infertility were administered by local governments, resulting in substantial regional disparities in access. Under the new policy, for patients aged 18–40 years with breast cancer or hematologic malignancies, the national program covers oocyte cryopreservation for female patients and sperm cryopreservation for male patients before the initiation of gonadotoxic treatment. By supporting pre-treatment gamete cryopreservation, the program aims to preserve future reproductive potential before irreversible impairment of ovarian or testicular function occurs. As this national initiative evolves, robust population-based evidence on reproductive outcomes after cancer will be essential to guide policy refinement, expansion of eligibility criteria, and equitable allocation of healthcare resources. Given the absence of population-based data on childbirth after cancer in Taiwan, we conducted a nationwide, registry-based cohort study to examine the cumulative incidence of livebirth after a cancer diagnosis at age ≤ 39 years among Taiwanese females, and to assess variation by cancer type, age at diagnosis, calendar period, level of urbanization, and cancer treatment. ## Methods ### Data source Study data were obtained on September 1, 2025 through linkage of multiple nationwide registries in Taiwan, where each resident is assigned a unique personal identification number. Information on cancer diagnosis (type and date), residential location, and first-course treatments was derived from the Taiwan Cancer Registry (from 1979 to 2022), a population-based system to record all newly diagnosed cancer cases [[12](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358466#pone.0358466.ref012)]. Data on livebirths were obtained from the Birth Reporting Registry (from 2001 to 2023), which requires the birth attendant to report birth information to authorized health agencies within seven days of delivery [[13](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358466#pone.0358466.ref013)]. Mortality data were retrieved from the Taiwan Death Registry (up to 2023). From the Taiwan Cancer Registry, we identified all first invasive cancer diagnoses among women aged ≤39 years. Cancer types were classified into mutually exclusive categories according to the ICD-O-3/WHO 2008 definitions, with cancer diagnoses across different calendar periods harmonized to this common classification system: oral cavity and pharynx; nasopharynx; digestive system; colon and rectum; liver and intrahepatic bile duct; respiratory system; connective and soft tissue; skin; breast; cervix; uterus; ovary; urinary and other genital system; eye, brain and other nervous system; thyroid; lymphoma; leukemia; and other. Age at cancer diagnosis was grouped into six categories: 0–14, 15–19, 20–24, 25–29, 30–34, and 35–39 years. Calendar year of cancer onset was categorized into ≤2000, 2001–2004, 2005–2009, 2010–2014, 2015–2019, and 2020–2022. Level of urbanization was classified as rural, satellite, or urban, based on the report from the Center for Survey Research, Research Center for Humanities and Social Sciences, Academia Sinica [[14](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358466#pone.0358466.ref014)]. Cancer treatment was categorized into four mutually exclusive groups based on a clinical hierarchy: (1) chemotherapy (with or without surgery/radiation); (2) radiation, no chemotherapy (with or without surgery); (3) surgery only; and (4) other (including unknown or unspecified treatments). This study protocol was approved by the Institutional Review Board of National Cheng Kung University Hospital, Tainan, Taiwan. Datasets were obtained from the Health and Welfare Data Science Center, Ministry of Health and Welfare in Taiwan. ### Subsequent first childbirth for women with cancer Follow-up began on the date of cancer diagnosis. For individuals diagnosed before age 15 years, follow-up commenced at age 15. Women were followed until the earliest of the following events: first post-diagnosis livebirth, age 49 years, or the end of 2023. The earliest eligible patients in our cohort were those diagnosed during infancy in 1986, who subsequently survived and entered their reproductive age within our 2001–2023 tracking window; conversely, the latest eligible patients were those diagnosed in 2022 and followed through 2023. We excluded women with less than one year of follow-up; therefore, births occurring within one year after cancer diagnosis were not included. Thus, all included women conceived at least three months after their cancer diagnosis. This specific exclusion criteria was established to ensure that all recorded livebirths represented new conceptions initiated strictly during the post-diagnostic survivorship period [[8](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358466#pone.0358466.ref008)]. We estimated the 5-, 10-, and 15-year cumulative incidence of first livebirth after cancer using PROC LIFETEST in SAS, treating death as a competing event [[15](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358466#pone.0358466.ref015)]. To evaluate predictors of first livebirth, we fit cause-specific Cox models using PROC PHREG to obtain hazard ratios (HRs) and 95% confidence intervals (CIs) [[16](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358466#pone.0358466.ref016)]. Predictors included cancer type, age at diagnosis, period of cancer onset, level of urbanization, and cancer treatment. Multivariable models were performed that adjusted for cancer type, age at diagnosis, and period of cancer onset. We did not include cancer treatment in the models since it is a mediator rather than a confounding factor in the relationship between cancer diagnosis and subsequent childbirth. Level of urbanization was also not included due to its non-significant impact in the univariate model. To evaluate chronological or ordinal linear trends across grouped categories (such as age at diagnosis and period of cancer onset), the categorical variables were converted into ordinal scores by assigning sequential integers (e.g., 1, 2, 3, 4...) and the statistical significance of the linear trend was assessed. Proportional hazards assumptions were assessed by inspecting log(–log[survival]) versus log(time) plots. ### Standardized birth ratio (SBR) for women with cancer To compare the birth rate among women diagnosed with cancer at age ≤ 39 years with that of the general female population in Taiwan, we applied indirect standardization to estimate t
## Related Clinical Research

- [Sellas Phase 3 REGAL trial for galinpepimut-S faces delays and likely negative outcome in AML](https://medichelpline.com/clinical-feed/stat-news-1-stat-a-sellas-immunotherapy-study-long-delayed-will-end-in-failure.md)
- [TIGIT-CD155 interaction modulates adapter CAR-T cell function in AML — knockout screen findings](https://medichelpline.com/clinical-feed/pubmed-42750591.md) (DOI: 10.1080/2162402X.2026.2717853)
- [Targeting VISTA for Skin Cancer Immunotherapy: Source Article Not Available](https://medichelpline.com/clinical-feed/frontiers-in-immunology-17-targeting-vista-as-a-novel-immunotherapy-for-skin-cancer.md)
- [Increased 1-Year Risk of Ischemic Stroke After Invasive Cancer Diagnosis: Nationwide Cohort Study](https://medichelpline.com/clinical-feed/pubmed-42706874.md) (DOI: 10.1002/cncr.70536)
- [One-month physicochemical stability of idarubicin diluted in polyolefin (Freeflex) infusion bags](https://medichelpline.com/clinical-feed/plos-one-21-one-month-physicochemical-stability-study-of-idarubicin-prepared-in-polyolefin.md)

## Navigation
- [← Back to Oncology Feed](https://medichelpline.com/clinical-feed/oncology.md)
- [← All Clinical Specialties](https://medichelpline.com/clinical-feed.md)
## Medical & Regulatory Disclaimer

> [!CAUTION]
> MedicHelpline content is structured for research, educational, and professional discovery purposes. It does not constitute individual medical advice, clinical diagnosis, or treatment recommendations.
> Always verify dosing, contraindications, and regulatory alerts against official product labeling and primary regulatory sources before clinical decision-making.