Detailed inform­a­tion and a list of ref­er­ences can be found in Chapter 2.9 of the Fer­ti­PRO­TEKT book, “Indic­a­tions and fertility pre­ser­va­tion methods for onco­lo­gic­al and non-onco­lo­gic­al disorders”, which can be down­loaded free of charge.

General inform­a­tion

The most common malig­nan­cies are presented sep­ar­ately on the website and in the book mentioned above. Less common diseases are described in the table below. Due to the wide variety of malignant diseases, it is not possible to list them all. Since many are accom­pan­ied by radio­ther­apy, the general effects of pelvic radio­ther­apy on the function of the gonads and the uterus are described first.

Effects of radio­ther­apy on the ovaries and testes

The effect of radio­ther­apy on the ovaries and testes depends on the dose. Various doses and their effects are described below.

+ EFFECTS OF DIFFERENT RADIOTHERAPY DOSES (MEASURED IN GRAY) ON THE OVARIES

Effects Radio­ther­apy dose
No relevant effects 0,6 Gray
No relevant effects under the age of 40 years 1,5 Gray
Risk of a complete loss of ovarian function (infer­til­ity): about 60% between 15–40 years of age 2,5–5 Gray
Infer­til­ity with radio­ther­apy at the age of 10 years Ab 18 Gray
Infer­til­ity with radio­ther­apy at the age of 20 years Ab 16 Gray
Infer­til­ity with radio­ther­apy at the age of 30 years Ab 14 Gray
Infer­til­ity with radio­ther­apy at the age of 40 years Ab 7 Gray

+ EFFECTS OF DIFFERENT RADIOTHERAPY DOSES (MEASURED IN GRAY) ON THE TESTES

Effects Radio­ther­apy dose
Long-lasting infer­til­ity possible From 2 Gray
Permanent infer­til­ity possible From 4 Gray

EFFECTS OF RADIOTHERAPY ON THE FUNCTION OF THE UTERUS (WOMB)

There are few studies available; however the following con­clu­sions can be drawn:

  • Radio­ther­apy during childhood seems to have larger adverse effect on the uterus than radio­ther­apy during adulthood.
  • Radio­ther­apy to the uterus of an adult during total body irra­di­ation with 12 Gray is asso­ci­ated with an increased risk of mis­car­riages, premature births and low birth weight.
  • Pregnancy should be strictly dis­cour­aged after radio­ther­apy to the uterus during childhood with more than 25 Gray and during adulthood with more than 45 Gray.

further malignant diseases

Ewing’s sarcoma (bone cancer)

Incidence

Incidence of lim­it­a­tion of ovarian function caused by the required treatment

Risk of meta­stas­is to the ovaries

Fertility pre­ser­va­tion methods

New cases 3/1,000,000 children < 15 years, 2.4/ 1,000,000 adoles­cents and young adults

Over 50%,

espe­cially in com­bin­a­tion with radio­ther­apy or bone marrow transplant;

Radio­ther­apy: see above

Possible in indi­vidu­al cases

GnRH agonists,

Cryo­p­reser­va­tion of oocytes after stim­u­la­tion and cryo­p­reser­va­tion of ovarian tissue

Sperm cryo­p­reser­va­tion; possibly cryo­p­reser­va­tion of testic­u­lar tissue

Osteo­sar­coma (bone cancer)

Incidence

Incidence of lim­it­a­tion of ovarian function caused by the required treatment

Risk of meta­stas­is to the ovaries

Fertility pre­ser­va­tion methods

2–3 new cases / 1,000,000 persons

According to a study, 6 out of 90 young women have a complete loss of ovarian function after chemotherapy.

Possible in indi­vidu­al sarcoma cases

GnRH agonists,

Cryo­p­reser­va­tion of oocytes after stim­u­la­tion and cryo­p­reser­va­tion of ovarian tissue

Sperm cryo­p­reser­va­tion; possibly cryo­p­reser­va­tion of testic­u­lar tissue

Colorectal cancer (colorectal and colon cancer)

Incidence

Incidence of lim­it­a­tion of ovarian function caused by the required treatment

Risk of meta­stas­is to the ovaries

Fertility pre­ser­va­tion methods

New cases 70/100,000 (30% colorectal, 70% colon)

Less with chemo­ther­apy but high if pelvic radio­ther­apy is required and are the ovaries are in the field of radiation / scattered radiation.

Radio­ther­apy: see above

Low

Surgical relo­ca­tion of the ovaries if radio­ther­apy is performed if the ovaries lay within the radiation field.

GnRH agonists if chemo­ther­apy is given,

Cryo­p­reser­va­tion of oocytes after stim­u­la­tion and cryo­p­reser­va­tion of ovarian tissue

Sperm cryo­p­reser­va­tion; possibly cryo­p­reser­va­tion of testic­u­lar tissue

Non-hodgkin’s lymphoma (lymphoma, espe­cially so-called blastic and burkitt’s lymphoma)

Incidence

Incidence of lim­it­a­tion of ovarian function caused by the required treatment

 Risk of meta­stas­is to the ovaries

Fertility pre­ser­va­tion methods

5–10 new cases / 100,000 persons; rather in higher age groups

High or very high, depending on treatment

High for blastic and Burkitt’s lymphoma,

Otherwise moderate

GnRH agonists if chemo­ther­apy is given

Cryo­p­reser­va­tion of oocytes after stim­u­la­tion. No cryo­p­reser­va­tion of ovarian tissue because of the pos­sib­il­ity of tumour cell presence in the ovarian tissue.

Sperm cryo­p­reser­va­tion; possibly cryo­p­reser­va­tion of testic­u­lar tissue

Acute lymph­o­cyt­ic leukaemia (acute blood cancer)

Incidence

Incidence of lim­it­a­tion of ovarian function caused by the required treatment

Risk of meta­stas­is to the ovaries

Fertility pre­ser­va­tion methods

Incidence approx­im­ately 1.1 / 100,000 people, espe­cially in young people

without bone marrow trans­plant­a­tion usually high,

very high with bone marrow transplantation

High

GnRH Agonists if chemo­ther­apy is given

Cryo­p­reser­va­tion of oocytes after stim­u­la­tion usually not possible because time until chemo­ther­apy is insuf­fi­cient. Cryo­p­reser­va­tion of ovarian tissue: experimental.

If cryo­p­reser­va­tion of ovarian tissue should be carried out: after so-called induction chemo­ther­apy and when in so-called complete remission, if there is suf­fi­cient ovarian reserve.

Sperm cryo­p­reser­va­tion; possibly cryo­p­reser­va­tion of testic­u­lar tissue

Acute myeloid leukaemia (acute blood cancer)

Incidence

Incidence of lim­it­a­tion of ovarian function caused by the required treatment

Risk of meta­stas­is to the ovaries

Fertility pre­ser­va­tion methods

New cases in ca. 3.5 / 100,000 persons, espe­cially in older people

without bone marrow trans­plant­a­tion usually high,

very high with bone marrow transplantation

high

GnRH agonists if chemo­ther­apy is given

Cryo­p­reser­va­tion of oocytes after stim­u­la­tion usually not possible because time until chemo­ther­apy is insuf­fi­cient. Cryo­p­reser­va­tion of ovarian tissue: experimental.

If cryo­p­reser­va­tion of ovarian tissue should be carried out: after so-called induction chemo­ther­apy and when in so-called complete remission, if there is suf­fi­cient ovarian reserve.

Sperm cryo­p­reser­va­tion; possibly cryo­p­reser­va­tion of testic­u­lar tissue

Testic­u­lar cancer

Incidence

Incidence of lim­it­a­tion of testic­u­lar function caused by the required treatment

Fertility pre­ser­va­tion methods

New cases in ca. 9/100.000 men

207 men tried to father a child after chemo­ther­apy and / or radio­ther­apy: 77% suc­cess­ful, 5% after infer­til­ity treatment, 18% unsuccessful.

Cryo­p­reser­va­tion of sperm or in indi­vidu­al cases of testic­u­lar tissue;

Possibly cryo­p­reser­va­tion of testic­u­lar tissue in boys before puberty as a special exper­i­ment­al technique