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Sexuality and Reproductive Issues (PDQ®): Supportive care - Health Professional Information [NCI] - Fertility Issues


When male infertility is the result of abnormal hormone production, the use of hormone manipulation may lead to the return of sperm production.[15]

For women, a radiation dose of 5 Gy to 20 Gy administered to the ovary is sufficient to completely impair gonadal function, regardless of the patient's age; a dose of 30 Gy provokes premature menopause in 60% of women younger than 26 years.[16] In a study of children and adolescents diagnosed with cancer, female 5-year survivors were significantly less likely to have ever been pregnant when compared with their siblings. Survivors who received hypothalamic/pituitary radiation doses of 30 Gy or higher or ovarian/uterine radiation doses higher than 5 Gy and those who were treated with lomustine or cyclophosphamide were less likely to have ever been pregnant.[17] Women who are older than 40 years when undergoing treatment have a smaller pool of remaining oocytes and require only 5 to 6 Gy to produce permanent ovarian failure. TBI, when used before stem cell transplantation, is associated with more than 90% permanent gonadal failure in women overall and an incidence of pregnancy less than 3%.[9] The outlook for recovery of ovarian function before puberty is more favorable, particularly if radiation is delivered in several fractions.[14] Measurement of gonadal toxicity in women is more difficult to assess due to the relative inaccessibility of the ovary to biopsy (which would require laparoscopy). Therefore, the criteria most commonly used to determine ovarian failure are the following:

  • Menstrual and reproductive history.
  • Measurements of serum hormone levels.
  • Clinical evidence of ovarian function.

Several authors provide reviews of gonadal dysfunction in patients receiving chemotherapy [15] and the effect of cancer therapy on gonadal function.[4]

Preventive Strategies

For women, studies [18] have shown that movement of the ovaries out of the field of radiation (ovariopexy)-laterally, toward the iliac crest, or behind the uterus-may help preserve fertility when high doses of radiation therapy are being applied. By relocating the ovaries laterally it is possible to shield them during radiation of the para-aortic and femoral lymph nodes.[4] Pelvic radiation, however, still provokes an irradiation of the ovary of 5% to 10%, even if transposed outside the irradiation area.[16] Similar prevention strategies are available for men. When possible, lead shields are used to protect the testes.[4]

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