Fertility after cancer.

Abstract

Both chemotherapy and radiotherapy can cause infertility in a patient undergoing cancer therapy. As both the ovaries and uterus are involved in female patients, the effects are profound. Where cryopreservation is not used or is unavailable, reproductive options include spontaneous conception if fertility returns, donor gametes, adoption, and surrogacy. Semen, oocyte, embryo, and ovarian tissue cryopreservation all offer an opportunity for a pregnancy after cancer cure if natural fertility is not possible. The risks of fertility preservation are significant for women due to the risks of surgical procedures, ovarian hyperstimulation syndrome, and delay of cancer therapy. Pregnancies that establish in women after cancer cure have specific risks including premature labor, cesarean section, congenital anomalies, and the risk of transmitting disease associated with genetic history. Where ovarian reimplantation is considered, the risk of reimplantation of malignant cells must be considered particularly in hematological and breast disease.