Cancer treatment with radiation or certain chemotherapies can affect fertility transiently or permanently in both men and women, and infertility can cause profound anxiety and emotional strain during treatment for cancer and in the survivorship phase.1,2 The extent of infertility is dependent on the type of treatment, the combination of agents, their dose levels, and patient age.
As a result, the American Society of Clinical Oncology (ASCO) developed and updated in 2018 a clinical practice guideline for fertility preservation among men, women, and children with cancer.3
Mechanisms of Infertility
Female infertility after cancer treatment is a result of ovarian function impairment, either through the loss or damage of primordial follicles or damage to oocytes and granulosa cells.1
The number of primordial follicles is believed to be finite and is referred to as ovarian reserve. Alkylating agents in particular, such as cyclophosphamide, chlorambucil, busulfan, and melphalan, can cause a substantial decrease in ovarian reserve. Other potential mechanisms include direct DNA damage within oocytes, and impairment of ovarian blood volume and vascular function.