Reduced fertility is one clinical manifestation among other well known Fanconi 
anemia features. Most recipients of allogeneic hematopoietic stem cell 
transplantation suffer from secondary infertility owing to gonadal damage from 
myeloablative conditioning. In order to evaluate the rate of pregnancy in 
Fanconi anemia transplanted patients, we performed a retrospective analysis of 
female patients transplanted in 15 centers from 1976 to 2008. Among 578 
transplanted Fanconi anemia patients, we identified 285 transplanted females of 
whom 101 patients were aged 16 years or over. Ten became pregnant (4 twice). 
Before hematopoietic stem cell transplantation all had confirmed Fanconi anemia 
diagnosis. Median age at transplantation was 12 years (range 5-17 years). 
Conditioning regimen consisted of cyclophosphamide with or without irradiation. 
During follow up, 5 of 10 patients presented signs of ovarian failure. Among 
those, 2 patients spontaneously recovered regular menses, and 3 received 
hormonal replacement therapy. Pregnancy occurred from four to 17 years after 
hematopoietic stem cell transplantation. Three patients had preterm deliveries, 
one patient had a hysterectomy for bleeding. All 14 newborns had normal growth 
and development without congenital diseases. In conclusion, recovery of normal 
ovarian function and a viable pregnancy is a realistic but relatively rare 
possibility even in Fanconi anemia patients following hematopoietic stem cell 
transplantation. Mechanisms of fertility recovery are discussed.