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  • Title: The effect of cancer and its therapy upon fertility.
    Author: Barber HR.
    Journal: Int J Fertil; 1981; 26(4):250-9. PubMed ID: 6120905.
    Abstract:
    When gynecologic cancer is treated by either surgery or radiation therapy, definitive infertility usually results. However, less is known about the aftereffects of these therapies when they are applied to the growing number of nongynecologic cancers that are now curable. Late effects of cancer treatment after total body exposure and low dose ranges include impaired fertility because of radiosensitivity of the precursor cells of the gametes. In males, impaired fertility produces no associated loss of libido, but in females, hormonal production may stop or lessen, causing loss of libido. Of the cells involved in the various stages of spermatogenesis, the spermatogonial cells are the most radiosensitive. Directly after irradiation no change in fertility is expected because mature sperm are not affected, and the supply of mature sperm will only be interrupted when a deficit occurs as a result of damage done to the spermatogonia. In females, the situation is similar in regard to exposure of the ovaries; sterility would not be expected until a mature form and its radio-resistant precursors became depleted and no new eggs matured. The question of the genetic effects of irradiation is controversial. The chance that the offspring will show evidence of being compromised in the 1st or 2nd generation is small, but the problem may reveal itself in future generations. It has been estimated that 30-80 roentgens constitutes the radiation dose that would double the mutation rate. In men, decreased sperm production begins about 60-80 days after exposure and the duration of the decrease depends on the dose given. With single dose exposure, complete recovery of sperm production occurs up to 18 months after 100 rads or less, within 30 months after 300 rads, and 5 or more years after 600 rads. Testes receiving standard fractionated doses greater than a 1000 rads total dose will be sterile. Testosterone production remains normal unless the doses are very high. In an effort to prevent sterility in female patients undergoing radiotherapy, the ovaries may be surgically removed out of the treatment field at laparotomy. Subsequent pregnancies apparently result in normal children, but latent genetic change has not been evaluated. There is evidence that alkylating agents, probably the most commonly used drugs in cancer chemotherapy, may result in permanent sterility in some cases.
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