The Effects of Chemotherapy and Radiotherapy on Fertility in Premenopausal Women

Fleischer, Roni T.; Vollenhoven, Beverley; Weston, Gareth

doi:10.1097/ogx.0b013e318224e97b

Cited by 71 publications

(53 citation statements)

References 65 publications

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“…Again, the effects are particularly noted with oocyte and gonadal function 27 . As in the case of chemotherapy, treatmentspecific and patient-specific factors should both be considered.…”

Section: Effects In Womenmentioning

confidence: 98%

“…Anticancer medications may destroy the oocyte pool by interfering with processes specific to cell proliferation (cell-cycle specific), but may also act on cells not actively proliferating (non-cell-cycle specific). The latter actions tend to be more harmful 27 . The effects may be partial or complete and may in turn correlate with the patient's subsequent ovarian dysfunction 26 .…”

Section: Effects In Womenmentioning

confidence: 99%

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Oncofertility in Canada: The Impact of Cancer on Fertility

Ronn

Holzer

2013

Current Oncology

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Background: Cancer can be a devastating diagnosis. In particular, malignancy and its indicated treatments have profoundly negative effects on the fertility of young cancer patients. Oncofertility has emerged as a new interdisciplinary field to address the issue of gonadotoxicity associated with cancer therapies and to facilitate fertility preservation. In Canada, these fertility issues are often inadequately addressed despite the availability of resources. The goal of this four-part series is to facilitate systemic improvements in fertility preservation for adolescent and young adult Canadians with a new diagnosis of cancer. Methods: In this article, we review the gonadotoxic effects of cancer treatment on young men and women of reproductive age. Results: The detrimental effects of cancer on fertility can be severe and may vary depending on the chemotherapy, radiotherapy, or surgical treatments involved. Conclusions: Fertility preservation should be addressed in an effort to mitigate the gonadal damage that may come with cancer therapy.

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“…Again, the effects are particularly noted with oocyte and gonadal function 27 . As in the case of chemotherapy, treatmentspecific and patient-specific factors should both be considered.…”

Section: Effects In Womenmentioning

confidence: 98%

Section: Effects In Womenmentioning

confidence: 99%

Oncofertility in Canada: The Impact of Cancer on Fertility

Ronn

Holzer

2013

Current Oncology

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“…26% of patients who received whole abdominal irradiation at mean age of 3.45 years developed POI at an average age of 23.5 years [91]. Although best efforts are made to shield the gonads from radiation during cancer therapy, it is hard to preserve intact ovarian function.…”

Section: Iatrogenic Causesmentioning

confidence: 99%

“…The effect of chemotherapy and radiotherapy are dependent on types of drugs, location of radiation field, dose and age [15,91]. Ovaries of young women appear to be relatively resistant to these two forms of gonadotoxicity.…”

Section: Iatrogenic Causesmentioning

confidence: 99%

“…Alkylating agent cyclophosphamide (CYC) is a non-cell-cycle-specific drug that is cytotoxic even to resting cells [91], and results in up to 40% risk of ovarian failure at childbearing age [92]. Alkylating agents are reported to be of high risk of gonadotoxicity, while vinca alkaloids, anthracyclic antibiotics, and antimetabolites are of relatively low risk [93].…”

Section: Iatrogenic Causesmentioning

confidence: 99%

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An update on primary ovarian insufficiency

Jin

Huang

2012

Sci. China Life Sci.

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Primary ovarian insufficiency (POI) occurs in about 1% of female population under the age of 40, leading to reproductive problems, an earlier encounter with menopausal symptoms, and complicated diseases. There are three presumable mechanisms involved in the development of POI, namely apoptosis acceleration, follicular maturation blocking and premature follicle activation, through the following studied causes: (i) chromosomal abnormalities or gene mutations: mostly involve X chromosome, such as FMR1 premutation; more and more potentially causal genes have been screened recently; (ii) metabolic disorders such as classic galactosaemia and 17-OH deficiency; (iii) autoimmune mediated ovarian damage: observed alone or with some certain autoimmune disorders and syndromes; but the specificity and sensitivity of antibodies towards ovary are still questionable; (iv) iatrogenic: radiotherapy or chemotherapy used in cancer treatment, as well as pelvic surgery with potential threat to ovaries' blood supply can directly damage ovarian function; (v) virus infection such as HIV and mumps; (vi) toxins and other environmental/lifestyle factors: cigarette smoking, toxins (e.g., 4-vinylcyclohexene diepoxide), and other environmental factors are associated with the development of POI. The etiology of a majority of POI cases is not identified, and is believed to be multifactorial. Strategies to POI include hormone replacement and infertility treatment. Assisted conception with donated oocytes has been proven to achieve pregnancy in POI women. Embryo cryopreservation, ovarian tissue cryopreservation and oocyte cryopreservation have been used to preserve ovarian reserve in women undergoing cancer treatments. Primary ovarian insufficiency (POI), commonly referred to as premature ovarian failure (POF), is defined as the occurrence of amenorrhea (for 4 months or more) before the age of 40 in women, accompanied with an increase of serum FSH to menopausal level (usually over 40 IU L 1 , obtained at least 1 month apart), and estradiol levels less than 50 pg mL 1 (which indicate hypoestrogenism) [1]. Primary ovarian insufficiency is first brought to light by Fuller Albright in 1942, who emphasized that the end stage of ovarian function is the primary defect rather than abnormality in gonadotropin secretion [2], and avoided the discomforting and inaccurate stressing on "failure", like death-sentence for ovarian function and conception.Menopause is a destined phase of women, which is expected to occur at around the age of (50±4) years in US women [3]. The age of 40 is two standard deviations below this average [4]. With an incidence of 1% in women under the age of 40, and 0.1% in women under the age of 30 [5], POI renders patients estrogen deficiency and anovulation, resulting in vasomotor symptoms (hot flashes and night sweats), atrophic vaginitis, dyspareunia, primary or secondary amenorrhea, and infertility. 76% of POI cases developed after normal puberty and establishment of regular menses [6]. Some of such conditions occur after stopping...

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Discussions about reproductive and sexual health among young adult survivors of cancer

et al. 2016

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Fertility preservation and sexual health are increasingly important as more young cancer patients survive their disease. Our aims were to describe the frequency with which reproductive and sexual health discussions occur, and to identify clinical factors associated with these discussions. Medical records of patients aged 20–39 diagnosed with solid tumors from 2008–2010 who survived ≥2 years were retrospectively reviewed. Multivariate logistic models were used to explore the relationship between clinical factors and occurrence of discussions. We analyzed 427 survivors: median age was 35 years, 29% were men, 88% had baseline [Eastern Cooperative Oncology Group (ECOG)] ECOG 0, and 79% were in a relationship. Only 58% and 7% of patients received discussions about reproductive and sexual health, respectively, at their initial oncology consultation, most of which were led by medical oncologists. There was a significant association between reproductive and sexual health conversations, in that those who engaged in dialog about one topic were more likely to participate in discussions about the other (P = 0.01). Patients with gynecologic malignancies (P < 0.0001) were more inclined to engage in sexual health discussions. Only a minority (19%) of patients took specific action toward fertility preservation, but the receipt of reproductive health discussions was a strong and independent driver for pursuing fertility preservation (P < 0.0001). The impact of cancer and its treatment on fertility and sexual health was inadequately addressed at the time of diagnosis among young cancer survivors. This warrants specific attention since having reproductive health discussions was strongly predictive of patients pursuing fertility preservation strategies.

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The Effects of Chemotherapy and Radiotherapy on Fertility in Premenopausal Women

Cited by 71 publications

References 65 publications

Oncofertility in Canada: The Impact of Cancer on Fertility

Oncofertility in Canada: The Impact of Cancer on Fertility

An update on primary ovarian insufficiency

Discussions about reproductive and sexual health among young adult survivors of cancer

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