The effects of radiotherapy and chemotherapy on female reproduction

High dose chemotherapy and radiotherapy have radically increased long-term survival of young cancer patients, but major side effects of these treatmen ts are ovarian failure and infertility. Knowledge of the risks and probabil ities of ovarian failure caused by treatment is crucial for patients and ph ysicians in order to make informed choices that will best serve patients' i nterests. This review presents data on ovarian damage and failure following exposure to radiotherapy, chemotherapy and ablative therapy. The risk is e valuated from the published literature according to patient's age, treatmen t protocol and also according to the diagnosis of some common malignancies. Many of these patients will not be sterilized immediately following treatm ent, but will suffer from premature menopause. In order to prevent steriliz ation, ovarian transposition before pelvic irradiation is mandatory. Beside s cryopreservation of ovarian tissue and embryos before administration of c hemotherapy, the possible protective effect of pituitary-ovarian down-regul ation is discussed. The mechanism of primordial follicles damage induced by radio/chemotherapy is presented as well as the role of apoptosis signallin g pathways underlying destruction. Increased knowledge of these mechanisms could help to identify potential effective inhibitors that can block the pa th of primordial follicles destruction and reduce ovarian failure rate.