Abstract
Future fertility is of paramount importance to younger cancer survivors. Advances in assisted reproductive technology mean that young women treated with radiation involving the uterus may require clinical guidance regarding whether to attempt a pregnancy themselves. We performed a review of the literature regarding radiation involving uterus (total body irradiation (TBI) and pelvic radiation), fertility, and pregnancy outcomes to come up with a recommendation for our patients. Limited evidence suggests lower fecundity and an increased incidence of pregnancy complications after uterine radiation. Higher radiation doses and direct uterine radiation both significantly increase the risk of an adverse pregnancy outcome. Uterine radiation doses of <4 Gy do not appear to impair uterine function. Adult TBI data (usually 12 Gy) suggest pregnancy is possible but with lower fecundity and more complications. Although there is no clear data indicating the dose of radiation to the uterus, above which a pregnancy would not be sustainable, we suggest patients receiving >45 Gy during adulthood and >25 Gy in childhood be counselled to avoid attempting pregnancy. There is preliminary evidence that menopausal hormone therapy and a combination of pentoxifylline and tocopherol may improve uterine function following irradiation.
Highlights
Cancer is a leading cause of death in developed countries [1]
(ii) Previous uterine irradiation is associated with a smaller uterine volume; this can be related to direct radiation damage and/or hormonal depletion due to associated ovarian failure [15, 17]
(iii) The threshold radiation dose for uterine damage to occur such that pregnancy is not sustainable is unknown
Summary
Cancer is a leading cause of death in developed countries [1]. Treatment of cancer, in particular cancers of the pelvic or abdominal organs, may include radiation to the uterus by one of several means. TBI is often offered as part of a conditioning regime before stem cell or bone marrow transplant treatment [1, 2] This radiation commonly affects female fertility and when these malignancies occur in premenopausal women, the oncologist should discuss the likely consequences for fertility and the potential risks in pregnancy [3]. Depending on the dose and site, radiation can have a long-term impact on reproductive potential for cancer survivors With the wider availability of assisted reproductive technology, there are commonly opportunities for ovarian stimulation and oocyte or embryo cryopreservation prior to chemoradiation For those women who subsequently wish to utilise stored oocytes or embryos to achieve a pregnancy, there is very little evidence to guide whether the irradiated uterus can successfully and safely carry a pregnancy or whether surrogacy should be advised. Collection of data regarding the effects of radiation on the reproductive potential of the uterus (i.e., both the endometrium and the myometrium) will assist clinicians with making appropriate clinical judgements and treatment recommendations and this is currently underway at our centre
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