Impact of cancer treatments on fertility
|All AYA patients should be informed of the potential risks to their fertility and reproductive health of the recommended treatment.||B|
Many of the cancer therapies recommended for the most common cancers presenting in adolescents and young adults have the potential to cause impaired fertility in the short or long term.
For females, the major effect of cancer treatment on reproductive potential is via damage to the ovary and the oocytes with accelerated oocyte depletion. This can result in temporary or permanent ovarian failure and early menopause. Uterine damage is also a complication of pelvic radiotherapy.
For males, the major cause of impaired fertility is chemotherapy- or radiation-induced damage to sperm.
Therapies associated with the greatest risks to male and female fertility are:
- alkylating chemotherapy agents
- total body irradiation (as used in myeloablative stem-cell transplantation)
- cranial irradiation
This section summarises current evidence about the likely effect of common cancer treatments on female and male fertility.
However the scarcity of data regarding rates of male and female infertility after cancer treatment and the many patient factors that may influence fertility means it is difficult to precisely quantify an individual patient’s risk of infertility.
- Table 1: Representative rates of ovarian failure after treatment of common childhood and young adult cancers
- Table 2: Effect of cancer treatment on development of amenorrhea
- Levine J, Canada A, Stern CJ. Fertility preservation in adolescents and young adults with cancer. J Clin Oncol 2010 Nov 10;28(32):4831-41 [Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/20458029].
- Schover LR. Reproductive complications and sexual dysfunction in cancer survivors. In: Ganz PA, editor. Cancer survivorship: today and tomorrow. New York: Springer; 2007.