Gonadal dysfunction and fertility problems in cancer survivors

Figures & data

Figure 1.  Probability of first post-diagnosis parenthood according to age and gender in cancer patients aged 15–45 at diagnosis. Reprinted (modified) with permission from reference [23]© (2005) Oxford University Press.

Table I.  Risk of gonadal dysfunction according to cytotoxic drugs [11], [12], [46].

High risk	Medium risk	Low risk	Limited data
Alkylating drugs	Platinum analougs	Plant derivatives	Taxanes
Cyclophosphamide	Cisplatin	Vincristine	Oxaliplatin
Ifosfamide	Carboplatin	Vinblastine	Irinotecan
Busulfan	Doxorubicin	Antibiotics	Tyrosine kinase inhibitors
Melphalan		Bleomycin	Monoclonal antibodies
Chlorambucil		Dactinomycin
Chlormethine		Antimetabolites
Procarbazine		Methotrexate
		Mercaptopurine
		5-fluoruracil

Figure 2.  Actuarial post-treatment paternity rates according to treatment in 554 testicular cancer survivors who attempted post-treatment conception without the use of cryopreserved semen. RPLND = retroperitoneal lymph node dissection; RT = radiotherapy; cis = cumulative cisplatin dose. Reprinted (modified) with permission from reference [52]© (2005) Oxford University Press.

Table II.  Age adjusted odds ratios for hypogonadism (defined as s-testosterone below 8 nmol/l, using testosterone supplementation or a value of serum luteinizing hormone > 12 IU/l) in long term testicular cancer survivors compared to controls. Reprinted (modified) with permission from reference [55]© (2003) European Association of Urology.

	Hypogonadism	Adjusted odds ratios (95% CI)
Controls	5%	1.0
Testicular Cancer Survivors	16%	3.8 (2.0–7.3)
Treatment
Controls	5%	1.0
Surgery	9%	2.0 (0.9–4.2)
Radiotherapy	16%	3.5 (1.8–7.0)
Cisplatin ≤ 850 mg	19%	4.8 (2.4–9.5)
Cisplatin > 850 mg	27%	7.9 (3.6–17.4)

Table III.  Prevalence of POF among women treated for Hodgkin's lymphoma (HL) according to age, stage and chemotherapy given. Reprinted with permission from reference [57]© (2006) Oxford University Press.

	Number with POF/total (%)	p
Age at diagnosis HL		1.00
9–29 years	23/62 (37%)
30–40 years	14/37 (38%)
Stage at diagnosis HL		0.03
Stage I and II	20/67 (30%)
Stage III and IV	17/32 (53%)
Chemotherapy		<0.001
No	4/32 (13%)
Yes, all	33/67 (49%)
Yes, without alkylating agents^a	3/13 (23%)
Yes, including alkylating agents^b	30/54 (56%)

^aEpirubicine, bleomycin, vinblastine, prednisone (EBVP) or adriamycin, bleomycin, vincristine, dacarbazine (ABOD).

^bMustine, vinblastine, procarbazine, prednisone (MVPP) or chlorambucil, vinblastine, procarbazine, prednisone (ChlVPP).

Table IV.  Laboratory based monitoring of gonadal function in oncological practice.

	Female	Male
s-Luteinising Hormone	Early follicular phase (day 1–3)	Independent of time
s-Follicle stimulating Hormone	Early follicular phase (day 1–3)	Independent of time
s-Oestradiol	Early follicular phase (day 1–3)	Not necessary
s-Testosterone	Not necessary	Early morning due to diurnal variations
s-SHBG	Not necessary	To estimate free and bioavailable testosterone
s-Progesterone	Late follicular phase (day 21–23)*	Not relevant
Sperm analysis	Not relevant	Should be repeated with at least 2 weeks interval

*To verify if ovulation has taken place.

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