Abstract
Malignant hematological conditions have recognized an increased incidence and require aggressive treatments. Targeted chemotherapy, accompanied or not by radiotherapy, raises the chance of defeating the disease, yet cancer protocols often associate long-term gonadal consequences, for instance, diminished or damaged ovarian reserve. The negative effect is directly proportional to the types, doses, time of administration of chemotherapy, and irradiation. Additionally, follicle damage depends on characteristics of the disease and patient, such as age, concomitant diseases, previous gynecological conditions, and ovarian reserve. Patients should be adequately informed when proceeding to gonadotoxic therapies; hence, fertility preservation should be eventually regarded as a first-intention procedure. This procedure is most beneficial when performed before the onset of cancer treatment, with the recommendation for embryos or oocytes’ cryopreservation. If not feasible or acceptable, several options can be available during or after the cancer treatment. Although not approved by medical practice, promising results after in vitro studies increase the chances of future patients to protect their fertility. This review aims to emphasize the mechanism of action and impact of chemotherapy, especially the one proven to be gonadotoxic, upon ovarian reserve and future fertility. Reduced fertility or infertility, as long-term consequences of chemotherapy and, particularly, following bone marrow transplantation, is often associated with a negative impact of recovery, social and personal life, as well as highly decreased quality of life.
Highlights
Malignant conditions, among them hematological ones, have lately proved an increased incidence among young, reproductive-age humans
This review aims to raise the awareness of the multidisciplinary medical team regarding fertility consequences for cancer patients when administrating specific and proven gonadotoxic treatment
A research of the literature was conducted in the databases of PubMed and EMBASE to select full-length articles published in peer-reviewed journals up to October 2021. Both mechanisms of action related to gonadotoxic chemotherapy and irradiation, as well as fertility preservation protocols, were analyzed
Summary
Among them hematological ones, have lately proved an increased incidence among young, reproductive-age humans. Onco-hematological conditions face the most aggressive treatment protocols, such as bone marrow transplants, with terrible consequences over the reproductive tissue [2]. The effect of aggressive cancer treatment upon reproductive tissue is often not considered when facing a life-threatening condition. The decrease in follicle pool impacts the window of opportunity for the patient to procreate. As well as fertility preservation procedures, are not recommended within the first two years following aggressive chemotherapy treatment, as bone marrow transplantation. For a patient with a decreased ovarian reserve, this amount of time reduces, even more, the opportunity to use the remaining follicles. Aside from the follicle impact, damage to the genital tract is common. Additional negative impact reflects on both general genital function and pregnancy outcome [4,5]
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