Loading…

Protocol - Offspring and Fertility History

Add to My Toolkit
Description

The Offspring/Pregnancy History section of the Childhood Cancer Survivor Study includes three self-administered questions for males and females about pregnancy, pregnancy outcomes, and/or the ability to father children.

Specific Instructions

The Sickle Cell Disease Genitourinary Working Group notes the sensitive nature of some questions may bring back past painful experiences for respondents. Investigators should provide a private space for completing assessments and to be prepared to offer appropriate support.

Protocol

Offspring/Pregnancy History section of the Childhood Cancer Survivor Study (CCSS)

1. Have you and a partner ever become pregnant?
 [ ] No -> go to end
 [ ] Yes

2. Including live births, stillbirths, miscarriages, and abortions, how many times have you become pregnant or had a woman become pregnant by you?

Times

3. Please fill in the following information for each of your pregnancies, or each time a woman has become pregnant by you, regardless of the outcome.

Outcome

Your age (years) at beginning of pregnancy

Weeks pregnancy lasted

Live birth

Stillbirth

Miscarriage

Medical abortion

Under 15

15–20

21–25

26–30

31–35

36 and over

Less than 12 weeks

12 – 24 weeks

25 – 32 weeks

33 – 37 weeks

38 – 40 weeks

Pregnancy 1

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

Pregnancy 2

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

Pregnancy 3

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

Pregnancy 4

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

Pregnancy 5

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

(Please attach a separate sheet of paper, if more than 5 pregnancies.)

Availability

Available

Personnel and Training Required

None

Equipment Needs

None

Requirements
Requirement CategoryRequired
Major equipment No
Specialized training No
Specialized requirements for biospecimen collection No
Average time of greater than 15 minutes in an unaffected individual No
Mode of Administration

Self-administered questionnaire

Lifestage

Adolescent, Adult

Participants

Adolescent and adult males and females

Selection Rationale

The Offspring/Pregnancy History section of the Childhood Cancer Survivor Survey is a validated, self-administered questionnaire about pregnancy history and pregnancy outcome to determine fertility in a population with chronic illness.

Language

English

Standards
StandardNameIDSource
Derived Variables

None

Process and Review

Not applicable

Protocol Name from Source

Childhood Cancer Survivor Study (CCSS)

Source

Green, D. M., Whitton, J. A., Stovall, M., Mertens, A. C., Donaldson, S. S., Ruymann, F. B., Pendergrass, T. W., & Robison, L. L. (2002). Pregnancy outcome of female survivors of childhood cancer: A report from the Childhood Cancer Survivor Study. American Journal of Obstetrics and Gynecology, 187(4), 1070–1080. https://doi.org/10.1067/mob.2002.126643

General References

Green, D. M., Whitton, J. A., Stovall, M., Mertens, A. C., Donaldson, S. S., Ruymann, F. B., Pendergrass, T. W., & Robison, L. L. (2003). Pregnancy outcome of partners of male survivors of childhood cancer: A report from the Childhood Cancer Survivor Study. Journal of Clinical Oncology, 21(4), 716–721. https://doi.org/10.1200/JCO.2003.04.085

Protocol ID

880701

Variables
Export Variables
Variable Name Variable IDVariable DescriptiondbGaP Mapping
PX880701_Fertility_History_Ever_Pregnant
PX880701010000 Have you and a partner ever become pregnant? N/A
PX880701_Fertility_History_Number_Times_Pregnant
PX880701020000 Including live births, stillbirths, more
miscarriages, and abortions, how many times have you become pregnant or had a woman become pregnant by you? show less
N/A
PX880701_Fertility_History_Pregnancy_1_Age
PX880701030200 Pregnancy 1 - Your age (years) at beginning more
of pregnancy show less
N/A
PX880701_Fertility_History_Pregnancy_1_Duration
PX880701030300 Pregnancy 1 - Weeks pregnancy lasted N/A
PX880701_Fertility_History_Pregnancy_1_Outcome
PX880701030100 Pregnancy 1 - Outcome N/A
PX880701_Fertility_History_Pregnancy_2_Age
PX880701040200 Pregnancy 2 - Your age (years) at beginning more
of pregnancy show less
N/A
PX880701_Fertility_History_Pregnancy_2_Duration
PX880701040300 Pregnancy 2 - Weeks pregnancy lasted N/A
PX880701_Fertility_History_Pregnancy_2_Outcome
PX880701040100 Pregnancy 2 - Outcome N/A
PX880701_Fertility_History_Pregnancy_3_Age
PX880701050200 Pregnancy 3 - Your age (years) at beginning more
of pregnancy show less
N/A
PX880701_Fertility_History_Pregnancy_3_Duration
PX880701050300 Pregnancy 3 - Weeks pregnancy lasted N/A
PX880701_Fertility_History_Pregnancy_3_Outcome
PX880701050100 Pregnancy 3 - Outcome N/A
PX880701_Fertility_History_Pregnancy_4_Age
PX880701060200 Pregnancy 4 - Your age (years) at beginning more
of pregnancy show less
N/A
PX880701_Fertility_History_Pregnancy_4_Duration
PX880701060300 Pregnancy 4 - Weeks pregnancy lasted N/A
PX880701_Fertility_History_Pregnancy_4_Outcome
PX880701060100 Pregnancy 4 - Outcome N/A
PX880701_Fertility_History_Pregnancy_5_Age
PX880701070200 Pregnancy 5 - Your age (years) at beginning more
of pregnancy show less
N/A
PX880701_Fertility_History_Pregnancy_5_Duration
PX880701070300 Pregnancy 5 - Weeks pregnancy lasted N/A
PX880701_Fertility_History_Pregnancy_5_Outcome
PX880701070100 Pregnancy 5 - Outcome N/A
Genitourinary
Measure Name

Fertility History

Release Date

August 15, 2023

Definition

A measure to assess a participant’s fertility history, including the ability to become pregnant or to father children, the number of pregnancies, and the outcome of those pregnancies.

Purpose

This measure can be used to understand pregnancy history and pregnancy outcomes in patients with chronic medical conditions, such as sickle cell disease.

Keywords

offspring and fertility history, fertility, offspring, pregnancy, infertility, SCD, sickle cell disease, chronic disease, CCSS, Childhood Cancer Survivor Study

Measure Protocols
Protocol ID Protocol Name
880701 Offspring and Fertility History
Publications

There are no publications listed for this protocol.