Chemotherapy and radiotherapy treatments can cause damage in the gonads. Doctors need to make this fact known for patients that are going to go through any of these treatments.
The most important is to value the existing risk of gonad damage and provide an individual option to each and every patient. That’s why contacting the oncologist is always vital.
There are several factors that must be taken into account when it comes to valuing chemotherapy and radiotherapy, mainly: the toxicity degree of the treatment and the age of the patient.
Toxicity of the treatment
The possibility of suffering from ovarian failure, due to the different treatments with antineoplastic drugs, i.e. substances that prevent the growth or development of malignant tumour cells, is widely known. Ovarian failure may appear in 15% of treated acute myeloblastic leukaemias, 44% of non-Hodgkin lymphomas, 32% of Hodgkin lymphomas and 50% of breast cancers.
A dose of 20 Gy may cause an irreversible menopause in women younger than 40, whereas a dose of 6Gy may cause it only from 40 on.
The different chemotherapy treatments damage the clue and theca cells, and oocytes. There’s a great follicle loss due to the fact that the clue cells main function is the production of sexual steroids, such as luteal hormone, which may maintain a potential pregnancy and causes the production of the thick cervical mucus that prevents the spermatozoa from entering the uterus.
Age of the patient
The older the woman, the greater the gonad damage, due to the apparition of an irreversible amenorrhea after the oncologic treatment. The possibility that a hidden ovarian failure, continuing with the cycles some time after the end of the treatment, takes place must be taken into account.
Even if there are regular cycles, it doesn’t mean that there’s no irreversible damage in the ovarian follicle pool of the woman. Studies that followed the evolution of these patients during certain time have proved that the apparition of premature menopause has a higher incidence in these women than in normal population.
We must work to achieve:
- Defining the safety and effectiveness of the different treatments.
- Providing good markers of ovarian functionality and risk of toxicity in the gonads.
- The development of lab techniques, especially the in vitro follicle development.
- Creation of committees that include gynaecologists, specialists in assisted reproduction techniques, haematologists, oncologists, psychologists, paediatricians… to improve the attention to these women.
- Educating and raising awareness among the oncologists when it comes to the preservation of fertility of the patients.