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Impact of Chemotherapy and Radiotherapy on the Ovary

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Fertility Preservation

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Abstract

Chemotherapy and radiation can both significantly decrease fertility potential. For chemotherapy, factors such as dose, age of patient, type of cancer, and type of drug being used are the most significant prognostic factors in determining future reproductive potential. As the dose and age of a patient increases, the chance of pregnancy decreases. Alkylating agents are the biggest culprits of decreased fertility. Some cancers that are more associated with decreased fertility potential are Hodgkin’s lymphoma and breast cancer. For radiotherapy, the most significant factors for future reproductive potential are dose and location. Radiotherapy to the ovaries is the most significant risk factor for acute ovarian failure. There is a direct inverse relationship between radiation dose and fertility potential. Considering the high cure rate of childhood cancers and the deleterious long-term effects of chemotherapy and radiation, it is important to be familiar with both the treatment options for cancer and future fertility.

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References

  1. Stovall D, McGee E. How chemotherapy harms ­ovarian function and how to assess your patients’ risk and reproductive status. Srm-ejournal.com. Accessed September 2, 2010.

    Google Scholar 

  2. Childhood cancers: National Cancer Institute. http://www.cancer.gov/cancertopics/factsheet/Sites-Types/childhood. Accessed September 2, 2010.

  3. Larsen EC, Müller J, Schmiegelow K, Rechnitzer C, Andersen AN. Reduced ovarian function in long-term survivors of radiation- and chemotherapy-treated childhood cancer. J Clin Endocrinol Metab. 2003;88(11):5307–14.

    Article  PubMed  CAS  Google Scholar 

  4. Cohen L. Cancer treatment and the ovary: the effects of chemotherapy and radiation. Ann N Y Acad Sci. 2008;1135:123–5.

    Article  PubMed  CAS  Google Scholar 

  5. Salooja N, Reddy N, Apperley J. Vulnerability of the reproductive system to radiotherapy and chemotherapy. In: Tulandi T, Gosden R, editors. Preservation of fertility. London: Taylor & Francis; 2004. p. 39–64.

    Google Scholar 

  6. Johnston RJ, Wallace WH. Normal ovarian function and assessment of ovarian reserve in the survivor of childhood cancer. Pediatr Blood Cancer. 2009;53(2):296–302.

    Article  PubMed  Google Scholar 

  7. Tarlatzis BC, Zepiridis L. Perimenopausal conception. Ann N Y Acad Sci. 2003;997:93–104.

    Article  PubMed  Google Scholar 

  8. Byrne J, Fears TR, Gail MH, Pee D, Connelly RR, Austin DF, et al. Early menopause in long-term survivors of cancer during adolescence. Am J Obstet Gynecol. 1992;166(3):788–93.

    PubMed  CAS  Google Scholar 

  9. Byrne J. Infertility and premature menopause in ­childhood cancer survivors. Med Pediatr Oncol. 1999;33(1):24–8.

    Article  PubMed  CAS  Google Scholar 

  10. Knopman JM, Papadopoulos EB, Grifo JA, Fino ME, Noyes N. Surviving childhood and reproductive-age malignancy: effects on fertility and future parenthood. Lancet Oncol. 2010;11(5):490–8.

    Article  PubMed  Google Scholar 

  11. Knauff EA, Marinus JC, Eijkemans MJ, et al. Anti-müllerian hormone, inhibin B, and antral follicle count in young women with ovarian failure. J Clin Endocrinol Metab. 2009;94(3):786–92.

    Article  PubMed  CAS  Google Scholar 

  12. Bath LE, Wallace WHB, Shaw MP, Fitzpatrick C, Anderson RA. Depletion of ovarian reserve in young women after treatment for cancer in childhood: detection by anti-Mullerian hormone, inhibin B and ovarian ultrasound. Hum Reprod. 2003;18(11):2368–74.

    Article  PubMed  CAS  Google Scholar 

  13. Muttukrishna S, McGarrigle H, Wakim R, Khadum I, Ranieri DM, Serhal P. Antral follicle count, anti-mullerian hormone and inhibin B: predictors of ovarian response in assisted reproductive technology. BJOG. 2005;112(10):1384–90.

    Article  PubMed  CAS  Google Scholar 

  14. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ. Cancer statistics. CA Cancer J Clin. 2009;59(4):225–49.

    Article  PubMed  Google Scholar 

  15. Anderson RA, Themmen APN, Qahtani AA, Groome NP, Cameron DA. The effects of chemotherapy and long-term gonadotrophin suppression on the ovarian reserve in premenopausal women with breast cancer. Hum Reprod. 2006;21(10):2583–92.

    Article  PubMed  CAS  Google Scholar 

  16. Meirow D, Dor J, Kaufman B, Shrim A, Rabinovici J, Schiff E, et al. Cortical fibrosis and blood-vessels damage in human ovaries exposed to chemotherapy. Potential mechanisms of ovarian injury. Hum Reprod. 2007;22(6):1626–33.

    Article  PubMed  CAS  Google Scholar 

  17. Meirow D. Ovarian injury and modern options to ­preserve fertility in female cancer patients treated with high dose radio-chemotherapy for hemato-­oncological neoplasias and other cancers. Leuk Lymphoma. 1999;33(1–2):65–76.

    PubMed  CAS  Google Scholar 

  18. Blumenfeld Z. Gynaecologic concerns for young women exposed to gonadotoxic chemotherapy. Curr Opin Obstet Gynecol. 2003;15(5):359–70.

    Article  PubMed  Google Scholar 

  19. Ben-Aharon I, Bar-Joseph H, Tzarfaty G, Kuchinsky L, Rizel S, Stemmer SM, et al. Doxorubicin-induced ovarian toxicity. Reprod Biol Endocrinol. 2010;8:20.

    Article  PubMed  Google Scholar 

  20. Chemaitilly W, Mertens AC, Mitby P, Whitton J, Stovall M, Yasui Y, et al. Acute ovarian failure in the childhood cancer survivor study. J Clin Endocrinol Metab. 2006;91(5):1723–8.

    Article  PubMed  CAS  Google Scholar 

  21. Schwartz C. Long-term survivors of childhood cancer: the late effects of therapy. Oncologist. 1999;4(1): 45–54.

    PubMed  CAS  Google Scholar 

  22. Green DM, Sklar CA, Boice Jr JD, Mulvihill JJ, Whitton JA, Stovall M, et al. Ovarian failure and reproductive outcomes after childhood cancer treatment: results from the Childhood Cancer Survivor Study. J Clin Oncol. 2009;27(14):2374–81.

    Article  PubMed  Google Scholar 

  23. Shamberger RC, Rosenberg SA, Seipp CA, et al. Effects of high-dose methotrexate and vincristine on ovarian and testicular functions in patients undergoing postoperative adjuvant treatment of ostosarcoma. Cancer Treat Rep. 1981;65:739–746.

    Article  PubMed  Google Scholar 

  24. Koyama H, Wada T, Nishizawa Y, et al. Cyclophosphamide-induced ovarian failure and its therapeutic significance in patients with breast cancer. Cancer. 1977;39:1403–1409.

    Article  PubMed  Google Scholar 

  25. Blumenfeld Z. Preservation of fertility and ovarian function and minimalization of chemotherapy associated gonadotoxicity and premature ovarian failure: the role of inhibin-A and -B as markers. Mol Cell Endocrinol. 2002;187(1–2):93–105.

    Article  PubMed  CAS  Google Scholar 

  26. Wallace WHB, Anderson RA, Irvine DS. Fertility preservation for young patients with cancer: who is at risk and what can be offered. Lancet Oncol. 2005;6(4): 209–18.

    Article  PubMed  Google Scholar 

  27. Blumenfeld Z, Avivi I, Ritter M, Rowe JM. Preservation of fertility and ovarian function and minimizing chemotherapy-induced gonadotoxicity in young women. J Soc Gynecol Investig. 1999;6(5):229–39.

    Article  PubMed  CAS  Google Scholar 

  28. Kovacs P. Preserving ovarian function after breast cancer treatment. http://www.medscape.com/viewarticle/701901. Accessed September 2010.

  29. Anchan RM, Ginsburg ES. Fertility concerns and preservation in younger women with breast cancer. Crit Rev Oncol Hematol. 2010;74(3):175–92.

    Article  PubMed  Google Scholar 

  30. Arya LS, Kotikanyadanam SP, Bhargava M, Saxena R, Sazawal S, Bakhshi S, et al. Pattern of relapse in childhood ALL: challenges and lessons from a uniform treatment protocol. J Pediatr Hematol Oncol. 2010;32(5):370–5.

    PubMed  Google Scholar 

  31. Veitia RA, Gluckman E, Fellous M, Soulier J. Recovery of female fertility after chemotherapy, irradiation, and bone marrow allograft: further evidence against ­massive oocyte regeneration by bone marrow-derived ­germline stem cells. Stem Cells. 2007;25(5): 1334–5.

    Article  PubMed  Google Scholar 

  32. Sarafoglou K, Boulad F, Gillio A, Sklar C. Gonadal func­tion after bone marrow transplantation for acute leukemia during childhood. J Pediatr. 1997;130(2): 210–6.

    Article  PubMed  CAS  Google Scholar 

  33. Liu J, Malhotra R, Voltarelli J, Stracieri AB, Oliveira L, Simoes BP, et al. Ovarian recovery after stem cell transplantation. Bone Marrow Transplant. 2008;41(3): 275–8.

    Article  PubMed  CAS  Google Scholar 

  34. Wallace WH, Thomson AB, Saran F, et al. Predicting age of ovarian failure after radiation to a field that includes the ovaries. Int J Radiat Oncol Biol Phys. 2005;62:738–44.

    Article  PubMed  Google Scholar 

  35. Thomas GM. Female genital tract. In: Cox J, Ang K, editors. Radiation oncology: rationale, technique, results. 8th ed. St. Louis, MO: Mosby; 2003. p. 758.

    Google Scholar 

  36. Ogilvy-Stuart AL, Shalet SM. Effect of radiation on the human reproductive system. Environ Health Perspect. 1993;101 Suppl 2:109–16.

    Article  PubMed  Google Scholar 

  37. Critchley HO, Bath LE, Wallace WH. Radiation damage to the uterus – review of the effects of treatment of childhood cancer. Hum Fertil (Camb). 2002;5(2):61–6.

    Article  Google Scholar 

  38. Bath LE, Critchley HOD, Chambers SE, Anderson RA, Kelnar CJ, Wallace WH. Ovarian and uterine characteristics after total body irradiation in childhood and adolescence: response to sex steroid replacement. Br J Obstet Gynaecol. 1999;106(12):1265–72.

    Article  PubMed  CAS  Google Scholar 

  39. Faddy MJ, Gosden RG. A model conforming the decline in follicle numbers to the age of menopause in women. Hum Reprod. 1996;11(7):1484–6.

    Article  PubMed  CAS  Google Scholar 

  40. Wallace WHB, Thomson AB, Saran F, Kelsey TW. Predicting age of ovarian failure after radiation to a field that includes the ovaries. Int J Radiat Oncol Biol Phys. 2005;62(3):738–44.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA

    Maya L. Kriseman BS (Medical Student)

  2. Department of Obstetrics and Gynecology, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA

    Ertug Kovanci MD (Assistant Professor)

Authors
  1. Maya L. Kriseman BS
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  2. Ertug Kovanci MD
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Editor information

Editors and Affiliations

  1. School of Medicine, Department of Obstetrics, Gynecology, Yale University, Cedar St. 333, New Haven, 06510, Connecticut, USA

    Emre Seli

  2. , Director, Center for Reproductive, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, 44195, Ohio, USA

    Ashok Agarwal

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Kriseman, M.L., Kovanci, E. (2012). Impact of Chemotherapy and Radiotherapy on the Ovary. In: Seli, E., Agarwal, A. (eds) Fertility Preservation. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-1783-6_4

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  • DOI: https://doi.org/10.1007/978-1-4419-1783-6_4

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  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4419-1782-9

  • Online ISBN: 978-1-4419-1783-6

  • eBook Packages: MedicineMedicine (R0)

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