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Review
. 2019 Apr 9;3(1):pkz008.
doi: 10.1093/jncics/pkz008. eCollection 2019 Mar.

Cancer Treatment-Related Infertility: A Critical Review of the Evidence

Philip D Poorvu, A Lindsay Frazier, Angela M Feraco, Peter E Manley, Elizabeth S Ginsburg, Marc R Laufer, Ann S LaCasce, Lisa R Diller, Ann H Partridge
Review

Cancer Treatment-Related Infertility: A Critical Review of the Evidence

Philip D Poorvu et al. JNCI Cancer Spectr. .

Abstract

Cancer treatments may compromise the fertility of children, adolescents, and young adults, and treatment-related infertility represents an important survivorship issue that should be addressed at diagnosis and in follow-up to ensure optimal decision-making, including consideration of pursuing fertility preservation. Risk of infertility varies substantially with patient and treatment factors. The ability to accurately assess fertility risk for many patients is hampered by limitations of the current literature, including heterogeneity in patient populations, treatments, and outcome measures. In this article, we review and synthesize the available data to estimate fertility risks from modern cancer treatments for both children and adult cancer survivors to enable clinicians to counsel patients about future fertility.

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Figures

Figure 1.
Figure 1.
Definitions of fertility-related outcomes.
Figure 2.
Figure 2.
Risks to female fertility associated with cancer treatments. AAD = alkylating agent dose; ABVD = doxorubicin, bleomycin, vinblastine, dacarbazine; AC = doxorubicin, cyclophosphamide; AC-T = doxorubicin, cyclophosphamide, paclitaxel; ALL = acute lymphoblastic leukemia; BEACOPP = bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone; CED = cyclophosphamide equivalent dose; CHOP = cyclophosphamide, doxorubicin, vincristine, prednisone; CI = confidence interval; CMF = cyclophosphamide, methotrexate, fluorouracil; CNS = central nervous system; HCT = hematopoietic cell transplantation; OR = odds ratio; RR = relative risk; TBI = total body irradiation.
Figure 3.
Figure 3.
Estimated risk to male and female fertility from select pediatric chemotherapy regimens using calculated cyclophosphamide equivalent dose (CED) and cisplatin exposures. *CED dose (mg/m2) = 1.0 (cyclophosphamide dose [mg/m2]) + 0.244 (ifosfamide dose [mg/m2]) + 0.857 (procarbazine dose [mg/m2]) + 14.286 (chlorambucil dose [mg/m2]) + 15.0 (carmustine dose [mg/m2]) + 16.0 (lomustine dose [mg/m2]) + 40 (melphalan dose [mg/m2]) + 50 (thiotepa dose [mg/m2]) + 100 (nitrogen mustard dose [mg/m2]) + 8.823 (busulfan dose [mg/m2]). HR = hazard ratio.
Figure 4.
Figure 4.
Risks to male fertility associated with cancer treatments. ABVD = doxorubicin, bleomycin, vinblastine, dacarbazine; ALL = acute lymphoblastic leukemia; BEACOPP = bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone; BEP = bleomycin, etoposide, cisplatin; CCSS = Childhood Cancer Survivor Study; CED = cyclophosphamide equivalent dose; CHOP = cyclophosphamide, doxorubicin, vincristine, prednisone; CNS = central nervous system; HCT = hematopoietic cell transplantation; PCI = prophylactic cranial irradiation; RPLND = retroperitoneal lymph node dissection; TBI = total body irradiation.
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