European Journal of Obstetrics & Gynecology and Reproductive Biology
ReviewThe effect of cancer treatment on female fertility and strategies for preserving fertility
Introduction
It is estimated that in 2010, every 250th adult will be a survivor of childhood cancer [1]. In the developed or Westernized countries, women are using better methods of contraception and are delaying childbearing for social or financial reasons, so that an increasing number of women are anxious to preserve their fertility when early-stage cancers are discovered [2], [3]. In addition, increasing numbers of patients with non-malignant autoimmune diseases, such as rheumatoid arthritis or systemic lupus erythematosus, as well as hematological diseases [4], are being successfully treated with chemotherapy or radiation therapy.
Cytotoxic therapy often results in premature ovarian failure (POF) [5]. Patients with POF have to face years of menopause and psychological problems, or else years of hormone replacement therapy. However, this substitution therapy is not capable of replacing the reproductive function of the ovaries.
This article reviews the literature on the topic, discusses the effects of cancer treatment on female fertility, and presents the options currently available – thanks to advances in assisted-reproduction technology – for maintaining fertility in women undergoing this type of treatment.
Section snippets
Radiotherapy-induced ovarian damage
Ionizing radiation has adverse effects on gonadal function at all ages. The degree and persistence of the damage depends on the dose, the irradiation field and the patient's age, with older women being at greater risk of damage [6].
Cranial irradiation for brain tumors with doses to the hypothalamic–pituitary area in excess of 30 Gy can in time cause hypogonadotropic hypogonadism in children [7].
The ovaries are exposed to significant doses of radiation when radiotherapy is used in the treatment
Ovarian transposition (oophoropexy)
For patients undergoing gonadotoxic radiotherapy, transposition of the ovaries out of the field of irradiation can maintain ovarian function. The most common indications are Hodgkin's disease, cervical and vaginal cancer, and pelvic sarcomas. The ovarian dose after transposition is reduced to approximately 5–10% of that in in situ ovaries [23].
Laparoscopic procedures are currently conducted for ovarian transposition, as they offer the following advantages: there are fewer adhesions;
Conclusions
Young female cancer patients are still being poorly counseled with regard to the negative impact of the treatment on their fertility and on their options for fertility preservation. This review has focused both on the effect of cancer treatments on fertility and on the various surgical and assisted-reproduction innovations that are available to provide the patient with the option of future pregnancies. As the emerging discipline of fertility preservation is steadily attracting increasing
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