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Therapy Insight: fertility in women after cancer treatment

Nature Clinical Practice Endocrinology & Metabolism volume 3, pages 819–826 (2007)Cite this article

Abstract

Cancer is the second-commonest cause of death in women under 40 years of age in Western Europe and the US. The survival of cancer patients has, nevertheless, improved during the past two decades. During this period, and especially during the last decade, there have been ground-breaking advances in the optimization of the quality of life of patients treated for cancer, in particular by the development of fertility-enhancing and fertility-preserving procedures in young patients treated for cancer. Surgery, chemotherapy and radiation therapy affect the fertility potential of women in different ways. Surgery to remove the uterus and ovaries has a direct impact on fertility. Radiation therapy (external or brachytherapy) can affect ovarian and also uterine function. Different drugs used in chemotherapy can directly influence ovarian function. Some markers have now been evaluated that are predictive of the potential toxic injury to the gonads and uterus. Various procedures have been proposed to preserve the fertility potential in women before anticancer treatment begins or after the tumor is treated; however, such optimization of management should only be undertaken if it does not have a deleterious effect on the survival of the patient.

Key Points

  • Alkylating agents are known to be the most toxic chemotherapeutic drugs with respect to gonadal function

  • Inhibin B, estradiol and anti-Müllerian hormone are good predictive markers of ovarian function

  • Measurement of uterine myocontractility is a good marker of uterine alteration after radiation therapy and correlates with the dose delivered

  • Conservative surgery can be used to preserve fertility in selected patients treated for gynecological malignancies

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Acknowledgements

We thank Lorna Saint Ange for editing the manuscript.

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Authors and Affiliations

  1. P Pautier is Assistant Professor in the Department of Medical Oncology, and C Haie-Meder is Head of the Department of Brachytherapy, P Morice is Head of the Unit of Gynecologic Surgery, at the Institut Gustave Roussy, Villejuif, France.,

    Philippe Morice, Patricia Pautier & Christine Haie-Meder

  2. R Frydman is Head of the Department of Obstetrics-Gynecology and Reproductive Medicine, and N Frydman is Assistant Professor in the Department of Genetics and Reproduction, R Fanchin is Head of the Unit of Reproductive Medicine, A Chauveaud-Lambling is Assistant Professor, Hôpital Antoine Beclère, Clamart, France.,

    Renato Fanchin, Aurelia Chauveaud-Lambling, René Frydman & Nelly Frydman

  3. P Morice is also Professor of Gynecology, R Fanchin is Professor of Obstetrics and Gynecology, and R Frydman is Professor of Obstetrics and Gynecology, at Université Paris XI, Kremlin-Bicêtre, France.,

    Philippe Morice, Renato Fanchin & René Frydman

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  1. Philippe Morice
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Correspondence to Philippe Morice.

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Morice, P., Pautier, P., Fanchin, R. et al. Therapy Insight: fertility in women after cancer treatment. Nat Rev Endocrinol 3, 819–826 (2007). https://doi.org/10.1038/ncpendmet0675

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