The improvements to oncology treatments and the efficiency of early screening programmes have led to the recovery and survival rates for some tumours increasing significantly. This increased life expectancy has caused us to turn our attention to the secondary effects of treatments using chemotherapy and radiotherapy, and in this respect, ovarian function and the preservation of fertility are two of the aspects which most concern women who have recovered from the disease, as these can affect their quality of life. Here at IVI we contribute to increasing their self-esteem through treatments for cancer patients.

Although many patients who are given chemotherapy can recover their ovarian function, there is a higher risk of premature ovarian failure, which depends in particular on age and on the type of agent used. In this respect, the most gonadotoxic chemicals are alkylating agents, such as cyclophosphamide.

The type of cancer which has the greatest effect on fertility is lymphoma, followed by breast cancer, which is the most common cancer during reproductive age.

There are currently several different options and treatments available to cancer patients for maintaining their fertility. These are: the vitrification of oocytes, freezing of ovarian tissue, medical protection of the gonads (GnRH agonists, Imatinib), transposition of the ovaries and in-vitro maturation of oocytes, although for some of these the results still need to be improved and they should only be offered as experimental treatments. These techniques are not mutually exclusive and can be used to complement each other.

While these treatments available to cancer patients cannot guarantee that pregnancy will be achieved in the future, they mean that it will at least be possibly to try. What it does help with is tackling a treatment which in many cases causes sterility, offering hope for the future.

Consequences

• The ovarian cortex contains a limited number of follicles, which gradually decreases throughout a woman’s life as a result of ovulation and especially due to atresia. Radiotherapy and chemotherapy speed up the natural reduction of the number of follicles and prevent these from maturing. This, together with the fact that ovaries cannot regenerate, can lead to premature ovarian failure.

• The number of primordial follicles which survive following exposure to chemotherapy depends on many different factors such as age, the type of cancer, the agent used (by itself or combined with other chemotherapy drugs or radiotherapy), the dose and the number of cycles.

• Not everybody will lose their reproductive capacity, but continuing to menstruate is not synonymous with fertility. Although ovarian function may be recovered, the quality of oocytes may be suboptimal.

• For pregnant women who had cancer during their childhood, a higher rate of miscarriage has been observed, as well as a greater incidence of intrauterine growth retardation and of premature birth.

• Premature ovarian failure, in addition to putting an end to reproductive function, can also lead in the long term to vasomotor, skeletal and cardiovascular problems, as a result of the cessation of hormonal function.